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High blood pressure and eye disease

Definition

Hypertensive retinopathy is damage to the retina from high blood pressure. The retina is the layer of tissue at the back part of the eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.

Alternative Names

Hypertensive retinopathy

Causes, incidence, and risk factors

High blood pressure can damage blood vessels in the retina. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be.

When you have diabetes, high cholesterol levels, or you smoke, you have a higher risk of damage and vision loss.

Rarely, a condition called malignant hypertension develops. Blood pressure readings suddenly become very high. Sometimes, the sudden rise in blood pressure can cause more severe changes in the eye.

Other problems with the retina are also more likely to occur, such as:

Symptoms

Most people with hypertensive retinopathy do not have symptoms until late in the disease.

Symptoms may include:

Sudden symptoms are a medical emergency.

Signs and tests

Using an instrument called an ophthalmoscope, your health care provider can see narrowing of blood vessels, and signs that fluid has leaked from blood vessels.

The degree of retina damage (retinopathy) is graded on a scale of 1 to 4:

  • At grade 1, you may not have symptoms.
  • In between grades 1 and 4, there are a number of changes in the blood vessels, leaking from blood vessels, and swelling in other parts of the retina.
  • Grade 4 retinopathy includes swelling of the optic nerve and of the visual center of the retina (macula). This swelling can cause decreased vision.

Fluorescein angiography may be used to examine the blood vessels.

Treatment

Controlling high blood pressure is the only treatment for hypertensive retinopathy.

Expectations (prognosis)

Patients with grade 4 (severe retinopathy) often have heart and kidney problems due to high blood pressure. They are also at higher risk for stroke.

The retina will generally recover if the blood pressure is controlled. However, some patients with grade 4 retinopathy will have permanent damage to the optic nerve or macula.

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have high blood pressure and vision changes or headaches occur.

Prevention

Controlling high blood pressure prevents changes in the blood vessels of the eye, as well as in other organs like the heart, kidneys, and brain.

References

Kovach JL, Schwartz SG, Schneider S, Rosen RB. Systemic hypertension and the eye. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 16th ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2012:chap 13.

Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. 2008;26(1):217-231.

Rogers AH. Hypertensive retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis Mo: Mosby Elsevier;2008:chap 6.15.


Review Date: 8/31/2010
Reviewed By: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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