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High Blood Pressure and Retina Problems

The retina is the lining at the back of the eye that senses light coming into the eye. 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 happen 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: increased narrowing of the retinal arteries
  • Grade 3: narrowed blood vessels plus bleeding in the retina
  • Grade 4: narrowed blood vessels, bleeding in the retina, and swelling of the optic nerve (the nerve located behind the eye that sends visual images to the brain). This can cause vision loss.

Grade 4 is a medical emergency. You must be treated in a hospital to lower your blood pressure.

How does it occur?

Hypertensive retinopathy can happen 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 get stiff and 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 nearby nerves called cotton wool spots.

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

What are the symptoms?

Early stages of hypertensive retinopathy may not cause symptoms. As hypertensive retinopathy gets worse, you may have:

  • 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. You may have:

  • your blood pressure checked
  • pictures taken of the back of your eye
  • an exam using drops to dilate your pupil and special lenses to look in the back of your eye

Your provider may refer you to a retina specialist.

How is it treated?

If you are diagnosed with hypertensive retinopathy, you need to work with your healthcare provider to get your blood pressure under control with diet, exercise, and possibly medicine. If you have grade 4, you will need to stay in the hospital until the severe high blood pressure is under control. Severe high blood pressure can damage your eyes, heart, and kidneys.

How long will the effects last?

If your blood pressure is not treated, it can cause a loss of vision that 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 care provider know that you have high blood pressure and what medicines you take. Keep all appointments for checkups. If you develop headaches or blurred vision, contact your provider right away.

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site:
Written by Dr. Daniel Garibaldi.
Published by RelayHealth.
Last modified: 2011-07-20
Last reviewed: 2010-10-27
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2011 RelayHealth and/or its affiliates. All rights reserved.
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