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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

High blood pressure and eye disease

Hypertensive retinopathy

Last reviewed: September 17, 2012.

Hypertensive retinopathy is damage to the retina 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.

Causes

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, 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.

Symptoms may include:

  • Double vision, dim vision, or vision loss

Sudden symptoms are a medical emergency.

Exams 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 damage to the retina (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, leaking from blood vessels, and swelling in other parts of the retina.
  • Grade 4 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 is the only treatment for hypertensive retinopathy.

Outlook (Prognosis)

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

When to Contact a Medical Professional

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.

References

  1. Kovach JL, Schwartz SG, Schneider S, Rosen RB. Systemic hypertension and the eye. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 16th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2012:chap 13.
  2. Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. 2008;26(1):217-231. [PubMed: 18249264]
  3. Rogers AH. Hypertensive retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, Mo: Mosby Elsevier; 2008:chap 6.15.

Review Date: 9/17/2012.

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. Health Solutions, Ebix, Inc.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

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 endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Interventions for helping people use eye drops as prescribed for raised eye pressure or glaucomaInterventions for helping people use eye drops as prescribed for raised eye pressure or glaucoma
    A large number of people do not use eye drops as prescribed. Glaucoma is a slowly progressive eye disease, which can result in severe vision loss. Drops prescribed for raised eye pressure or glaucoma are aimed at lowering the pressure to assist in reducing the rate of progression, or preventing the conversion of raised eye pressure to glaucoma. It is important that these eye drops are used continually, usually for life. Approximately one‐third of people who are prescribed eye drops for the first time fail to continue collecting prescriptions within the first year and even when patients collect prescriptions they do not always use the drops as frequently as they should. A number of reasons are thought to be the cause, for example, forgetfulness, being prescribed a large number of medications, difficulties instilling drops, lack of knowledge about glaucoma, a busy lifestyle and seeing no benefit.
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