High blood pressure and eye disease
Hypertensive retinopathyHigh blood pressure can damage blood vessels in the retina. 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.
Retina
The retina is the light-sensitive layer of tissue at the back of the eyeball. Images that come through the eye's lens are focused on the retina. Th...
Read Article Now Book Mark ArticleCauses
The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be.
You have a higher risk of damage and vision loss when you also have diabetes, high cholesterol level, or you smoke.
Rarely, very high blood pressure develops suddenly. However, when it does, it can cause severe changes in the eye.
Other problems with the retina are also more likely, such as:
- Damage to the nerves in the eye due to poor blood flow
Damage to the nerves in the eye
Optic nerve atrophy is damage to the optic nerve. The optic nerve carries images of what the eye sees to the brain.
Read Article Now Book Mark Article - Blockage of the arteries that supply blood to the retina
Blockage of the arteries
Retinal artery occlusion is a blockage in one of the small arteries that carry blood to the retina. The retina is a layer of tissue in the back of t...
Read Article Now Book Mark Article - Blockage of the veins that carry blood away from the retina
Blockage of the veins
Retinal vein occlusion is a blockage of the small veins that carry blood away from the retina. The retina is the layer of tissue at the back of the ...
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Symptoms
Most people with hypertensive retinopathy do not have symptoms until late in the disease.
Symptoms may include:
- Double vision, dim vision, or vision loss
- Headaches
Headaches
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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Sudden symptoms are a medical emergency. It often means that the blood pressure is very high.
Exams and Tests
Your health care provider will use an ophthalmoscope to look for narrowing of the blood vessels and signs that fluid has leaked from blood vessels.
Ophthalmoscope
Ophthalmoscopy is an examination of the back part of the eye (fundus), which includes the retina, optic disc, choroid, and blood vessels.
Read Article Now Book Mark ArticleThe degree of damage to the retina (retinopathy) is graded on a scale of 1 to 4:
- Grade 1: Usually you would not have symptoms.
- Grades 2 to 3: There are a number of changes in the blood vessels, leaking from blood vessels, and swelling in other parts of the retina.
- Grade 4: You will have swelling of the optic nerve and of the visual center of the retina (macula). This swelling can cause decreased vision.
You may need a special test to examine the blood vessels.
Test
Fluorescein angiography is an eye test that uses a special dye and camera to look at blood flow in the retina and choroid. These are the two layers ...
Read Article Now Book Mark ArticleTreatment
The only treatment for hypertensive retinopathy is to control high blood pressure.
Control high blood pressure
Hypertension is another term used to describe high blood pressure. High blood pressure can lead to: StrokeHeart attackHeart failureKidney diseaseEar...
Read Article Now Book Mark ArticleOutlook (Prognosis)
People with grade 4 (severe retinopathy) often have heart and kidney problems due to high blood pressure. They are also at higher risk for stroke.
In most cases, the retina will heal if the blood pressure is controlled. However, some people with grade 4 retinopathy will have lasting damage to the optic nerve or macula.
When to Contact a Medical Professional
Get emergency treatment if you have high blood pressure with vision changes or headaches.
References
Cheung CY, Wong TY. Hypertension. In: Sadda SVR, Sarraf D, Freund KB, et al, eds. Ryan's Retina. 7th ed. Philadelphia, PA: Elsevier; 2023:chap 52.
Levy PD, Brody A. Hypertension. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 70.
Rachitskaya AV. Hypertensive retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology. 5th ed. Philadelphia, PA: Elsevier; 2019:chap 6.18.
Essential hypertension
Animation
Hypertensive retinopathy - illustration
Damage to the retina from high blood pressure is called hypertensive retinopathy. It occurs as the existing high blood pressure causes changes to the microvasculature of the retina. Some of the first findings in the disease are flame hemorrhages and cotton wool spots. As hypertensive retinopathy progresses, hard exudates can appear around the macula along with swelling of the macula and the optic nerve, causing impairment of vision. In severe cases permanent damage to the optic nerve or macula can occur.
Hypertensive retinopathy
illustration
Retina - illustration
The retina is the internal layer of the eye that receives and transmits focused images. The retina is normally red due to its rich blood supply.
Retina
illustration
Hypertensive retinopathy - illustration
Damage to the retina from high blood pressure is called hypertensive retinopathy. It occurs as the existing high blood pressure causes changes to the microvasculature of the retina. Some of the first findings in the disease are flame hemorrhages and cotton wool spots. As hypertensive retinopathy progresses, hard exudates can appear around the macula along with swelling of the macula and the optic nerve, causing impairment of vision. In severe cases permanent damage to the optic nerve or macula can occur.
Hypertensive retinopathy
illustration
Retina - illustration
The retina is the internal layer of the eye that receives and transmits focused images. The retina is normally red due to its rich blood supply.
Retina
illustration
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Review Date: 8/22/2022
Reviewed By: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.