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Hypertensive retinopathy

Definition

Hypertensive retinopathy is damage to theretina 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.

See also: Diabetic 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.

Malignant hypertension may cause the following sudden symptoms, and should be considered 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, areas where blood vessels have leaked, and other parts of the retina.
  • Grade 4 hypertensive 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 (hypertension) is the only treatment for hypertensive retinopathy.

See also: Malignant hypertension for treatment of this disorder

Expectations (prognosis)

Patients with grade 4 (severe hypertensive retinopathy) often have heart and kidney complications of 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 hypertensive retinopathy will have permanent damage to the optic nerve or macula.

Complications

  • Complications associated with high blood pressure
  • Irreversible damage to the optic nerve or macula, resulting in vision problems

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. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2009: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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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