Hypertensive Retinopathy

What is hypertensive retinopathy?

The retina is the thin layer of tissue lining the back wall of the eye that turns light into vision. The retina has delicate blood vessels that can be affected by many medical conditions and eye diseases. If you have high blood pressure that is not well controlled, changes can occur in the retinal blood vessels. These changes are called hypertensive retinopathy. If hypertensive retinopathy is severe, it can affect your vision.

There are 4 grades of hypertensive retinopathy:

• Grade 1: slight narrowing of the retinal arteries (blood vessels)
• Grade 2: narrowing and irregularity of the retinal arteries
• Grade 3: Grade 2 changes plus bleeding in the retina
• Grade 4: Grade 3 changes plus optic nerve (the nerve that carries visual information from the eye to the brain) swelling

Grade 4 hypertensive retinopathy is a medical emergency that requires hospitalization for careful lowering of the blood pressure.

How does it occur?

Hypertensive retinopathy can occur when high blood pressure has not been well controlled for a long time, or if your blood pressure suddenly increases. The retinal arteries respond to high blood pressure by narrowing. Over time, the vessels become stiff and they can push on nearby retinal veins. Damage to the blood vessels can cause them to change shape over time. They may also leak, leading to retinal bleeding and swelling of the retina. You can also have swelling of surrounding nerves called cotton wool spots.

If your blood pressure suddenly increases, severe leakage can occur from the retinal arteries, causing bleeding within the retina and swelling of the retina and optic disc. This is called malignant hypertension.

What are the symptoms?

You will not notice symptoms from the early stages of hypertensive retinopathy. Symptoms of hypertensive retinopathy that occur later include:

• blurred vision
• headache (if your blood pressure is very high)

How is it diagnosed?

Your healthcare provider will ask about your symptoms, examine your eyes, and perform tests. Tests you may have are:

• an exam using drops to dilate your pupil and special lenses to look in the back of your eye (called a dilated exam)
• photos to document the appearance of the blood vessels in your retina and the optic nerve to compare with future examinations
• blood pressure measurements

Your provider may recommend that you see a retina specialist.

How is it treated?

If you are diagnosed with hypertensive retinopathy, you will be asked to see your healthcare provider to get your blood pressure under control with diet, exercise, and possibly medicine. If you have malignant hypertension, you will be admitted to the hospital to carefully control your blood pressure and prevent damage to other organs.

How long will the effects last?

If your blood pressure is not treated, you may develop permanent changes in the retinal arteries. This can cause a loss of vision from poor blood flow, swelling in the retina and blockage of the retinal veins. Some of these effects may be permanent.

How can I prevent hypertensive retinopathy?

If you have high blood pressure, be sure to talk to your healthcare provider about ways to lower your blood pressure with diet, exercise and medicine. Let your eye healthcare provider know that you have high blood pressure and what medicines you may be taking. Keep all scheduled appointments and let your healthcare providers know if you develop headaches or problems with your vision.