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High blood pressure and eye disease

Hypertensive retinopathy

 

High 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.

Causes

 

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 have diabetes, high cholesterol level, or you smoke.

Rarely, blood pressure readings suddenly become very high. However, when they do, 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
  • Blockage of the blood supply in the arteries to the retina
  • Blockage of the veins that carry blood away from the retina

 

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

Sudden symptoms are a medical emergency.

 

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.

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

  • Grade 1: You may 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.

A test used to examine the blood vessels may be needed.

 

Treatment

 

The only treatment for hypertensive retinopathy is to control high blood pressure.

 

Outlook (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

Kovach JL, Schwartz SG, Schneider S, Rosen RB. Systemic hypertension and the eye. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 3, chap 13.

Levy PD. Hypertension. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 84.

Rogers AH. Hypertensive retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 6.17.

 
  • Hypertensive retinopathy

    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

    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

      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

      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

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

      Tests for High blood pressure and eye disease

       

       

      Review Date: 8/20/2016

      Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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