Symptoms of Hypertensive Retinopathy
You probably won’t have any symptoms
until the condition has progressed extensively. Possible signs and symptoms
bursting of a blood vessel
double vision accompanied by
Get medical help immediately if your
blood pressure is high and you suddenly have changes in your vision.
Risk Factors for Hypertensive Retinopathy
following conditions put you at a higher risk for HR:
prolonged high blood pressure
the condition is more common in people of African descent, particularly
Afro-Caribbean people. Women are also more likely to be affected by blood
vessel damage than men.
- heart disease
- high cholesterol
- being overweight
- eating an unhealthy diet
- heavy alcohol consumption
Classification of Hypertensive Retinopathy
and severity of the retinopathy is generally represented on a scale of 1 to 4.
The scale is called the Keith–Wagener–Barker Classification System. The four
grades increase in severity:
On the lower
end of the scale, you may not have any symptoms. At grade 4, however, your
optic nerve may begin to swell and cause more serious vision problems.
High-grade retinopathy tends to indicate serious blood pressure concerns.
- In Grade 1, there’s a mild narrowing of the
- Grade 2 is similar to grade 1, but there’s more
severe or tighter constrictions of the retinal artery. This is called
arteriovenous, or AV, nipping.
- Grade 3 has the signs of grade 2, but there’s
also retinal edema, microaneurysms, cotton-wool spots (fluffy white lesions on
the retina), and retinal hemorrhages (bleeding).
- Grade 4 has severe signs of grade 3 along with
optic disc swelling called papilledema and macular edema. People with grade 4
retinopathy have a higher risk for stroke and may have kidney or heart disease.
Treatment for Hypertensive Retinopathy
treatment for HR involves controlling and lowering high blood pressure with a
combination of medications and lifestyle changes.
A diet high
in fruits and vegetables may help lower blood pressure. Regular physical
activity, reducing salt intake, and limiting the amount of caffeine and
alcoholic beverages you drink all contribute to healthy blood pressure as well.
If you smoke, take steps to quit. If you’re overweight, losing weight is an
effective strategy for controlling high blood pressure.
may prescribe blood pressure medications such as diuretics, beta blockers, or
control this condition by controlling your blood pressure. If your condition is
severe, however, you may have irreversible eye damage that causes permanent
prognosis is worse for higher grades of HR. Grades 3 and 4 are associated with
higher rates of:
uncontrolled hypertension and grade 4 HR, sometimes called the “malignant
stage,” have a generally poor prognosis for survival, according to Retinal specialist.
- heart attack
- congestive heart failure
changes to the arteries in the retina are generally not reversible. Even with
treatment, patients diagnosed with HR are at a higher risk for retinal artery
and vein occlusions, and other problems of the retina.
If you have
high blood pressure or HR, it’s important that your primary care doctor works
with your eye doctor (ophthalmologist) to determine an appropriate treatment
plan. They can work together to monitor your condition.
The retina is the tissue layer located in the back of
your eye. This layer transforms light into nerve signals that are then sent to
the brain for interpretation. When your blood pressure is too high, the
retina’s blood vessel walls may thicken. This may cause your blood vessels to
become narrow, which then restricts blood from reaching the retina. In some
cases, the retina becomes swollen.
Over time, high blood pressure can cause damage to the
retina’s blood vessels, limit the retina’s function, and put pressure on the
optic nerve, causing vision problems. This condition is called hypertensive
Causes of Hypertensive Retinopathy
Prolonged high blood pressure, or
hypertension, is the main cause of HR. High blood pressure is a chronic problem
in which the force of the blood against your arteries is too high. The force is
a result of the blood pumping out of the heart and into the arteries as well as
the force created as the heart rests between heartbeats. When the blood moves
through the body at a higher pressure, the tissue that makes up the arteries
will begin to stretch and will eventually become damaged. This leads to many
problems over time.
HR generally occurs after your blood
pressure has been consistently high over a prolonged period. Your blood
pressure levels can be affected by:
- a lack of physical activity
- being overweight
- eating too much salt
- a stressful lifestyle
- High blood pressure also runs in
How is Hypertensive Retinopathy Diagnosed?
will use a tool called an ophthalmoscope to examine your retina. This tool
shines a light through your pupil to examine the back of your eye for signs of
narrowing blood vessels or to see if any fluid is leaking from your blood
vessels. This procedure is painless. It takes less than 10 minutes to complete.
cases, a special test called fluorescein angiography is performed to examine
retinal blood flow. In this procedure, your doctor will apply special eye drops
to dilate your pupils and then take pictures of your eye. After the first round
of pictures, your doctor will inject a dye called fluorescein into a vein. They’ll
typically do this on the inside of the elbow. They’ll then take further
pictures as the dye moves into the blood vessels of your eye.
Complications of Hypertensive Retinopathy
HR are at risk of developing complications related to the retina. These include
HR are also at an increased risk of having a stroke or heart attack. One study found that people
with HR were more likely to suffer from a stroke than people without the
condition. This was true even in people with blood pressure controlled by treatment.
Another studyshowed both an increased
risk of stroke or cardiovascular disease in people with HR.
- Ischemic optic neuropathy occurs when high blood
pressure blocks off normal blood flow in the eyes, damaging the optic nerve.
The optic nerve carries images of what we see to the brain.
- Retinal artery occlusion occurs when the
arteries that carry blood to the retina become blocked by blood clots. When
this happens, the retina doesn’t get enough oxygen or blood. This results in
- Retinal vein occlusion occurs when the veins that
carry blood away from the retina become blocked by blood clots.
- Nerve fiber layer ischemia or damage to the
nerve fibers may lead to cotton-wool spots, which are fluffy white lesions on
- Malignant hypertension is a rare condition that
causes blood pressure to increase suddenly, interfering with vision and causing
sudden vision loss. This is a potentially life-threatening condition.