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.
Retina
The retina is the light-sensitive layer of tissue at the back of the eyeball. Images that come through the eye's lens are focused on the retina. Th...
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:
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Damage to the nerves in the eye
due to poor blood flow
Damage to the nerves in the eye
Optic nerve atrophy is damage to the optic nerve. The optic nerve carries images of what the eye sees to the brain.
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Blockage of the blood supply
in the arteries to the retina
Blockage of the blood supply
Retinal artery occlusion is a blockage in one of the small arteries that carry blood to the retina. The retina is a layer of tissue in the back of t...
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Blockage of the veins
that carry blood away from the retina
Blockage of the veins
Retinal vein occlusion is a blockage of the small veins that carry blood away from the retina. The retina is the layer of tissue at the back of the ...
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
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Headaches
Headaches
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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.
Ophthalmoscope
Ophthalmoscopy is an examination of the back part of the eye (fundus), which includes the retina, optic disc, choroid, and 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.
Test
Fluorescein angiography is an eye test that uses a special dye and camera to look at blood flow in the retina and choroid. These are the two layers ...
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.
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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
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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 - 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
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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
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High blood pressure
(In-Depth)
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Atherosclerosis
(Alt. Medicine)
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Crohn disease
(Alt. Medicine)
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Diabetes - type 2
(In-Depth)
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Diabetes - type 1
(In-Depth)
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Stroke
(Alt. Medicine)
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Sickle cell disease
(In-Depth)
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Stroke
(In-Depth)
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Glaucoma
(In-Depth)
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Parkinson disease
(Alt. Medicine)
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.