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Hypertensive Retinopathy: Causes, Symptoms, & Treatment

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High blood pressure is a problem experienced by millions of American adults. Many people know that high blood pressure can increase the risk of heart attacks, strokes, and kidney damage, but it is less known that high blood pressure can also cause eye problems from hypertensive retinopathy.

The early stages of hypertensive retinopathy, like hypertension itself, may not be noticeable. But the condition may be progressive and can lead to vision loss. 

What Is Hypertensive Retinopathy?

Hypertensive retinopathy is damage to the blood vessels in the eye (retinal vascular damage) caused by high blood pressure (hypertension).  

Retinopathy is damage to the retina from lack of blood flow. Diabetic retinopathy is a common form of this condition, but people who struggle with high blood pressure are at risk of hypertensive retinopathy

Like diabetic retinopathy, hypertensive retinopathy occurs because of damaged blood vessels around the retina. This causes tissue damage to this area that, when healthy, sends light signals through the optic nerve to the brain.

Hypertensive retinopathy is characterized by the following:

  • Arteriovenous nicking may be present, which are indentations (nicks) in the veins in the retina caused by stiff arteries in the retina. 
  • Narrowing of the arteries in the retina occurs.
  • Thickening of the walls of the arteries in the retina (called copper or silver-wiring) is present. Red arteries appear orange or gold for “copper.” A blocked artery appears white for “silver.”
  • In a hypertensive crisis, hemorrhages, cotton-wool spots, edema, and hardened yellow fluid may be present.  

What Causes Hypertensive Retinopathy?

Hypertensive retinopathy is caused by high blood pressure (hypertension). 

High blood pressure is a chronic problem that damages blood vessels all over your body and can lead to heart failure. With high blood pressure, blood pushes through artery walls with too much force. The heart has to work harder to push blood through with such force. This force, and the strain on the heart, affects the blood vessels and blood flow throughout the body. 

The risk of vision loss is greater for those who have hypertensive retinopathy and smoke, as well as for those who also have diabetes and/or high cholesterol levels. 

Symptoms of Hypertensive Retinopathy

Hypertension causes the walls of blood vessels to thicken, which decreases how much blood can flow through them. While a sudden hypertension emergency can cause sudden damage to the eye, often the effects of hypertension spread to the eye progressively. 

In the eyes, reduced blood supply to the retina can cause the tissues to starve and die, leading to vision loss. 

There may be no symptoms of hypertensive retinopathy in its early stages. Hypertensive retinopathy may not be noticed until it is in later stages and causing vision problems. 

Symptoms of late-stage hypertensive retinopathy include the following:

  • Dim vision
  • Double vision
  • Slow vision loss

This is one reason that it’s so important to keep up with regular eye exams. A doctor specializing in vision will be able to detect symptoms of hypertensive retinopathy in its early stages. 

Regular eye exams with dilated pupils and a slit lamp test can detect damage to your retina or changes to the blood vessels at the back of your eye.

The amount of blood vessel damage around the retina tends to correlate with blood vessel hardening and damage in other parts of the body. If you have severe hypertensive retinopathy, you may also have chest pain, kidney damage, and related problems.

Stages of Hypertensive Retinopathy

Generally, there are four stages of hypertensive retinopathy. Ophthalmologists and other eye specialists also use these stages to diagnose patients into grades. 

Grade 1: Vasoconstrictive Phase

There are no noticeable symptoms, but there are some blood vessel changes. The small arteries in the retina narrow.

Grade 2: Sclerotic Phase

Blood vessels have changed and hardened. Silver and copper wiring may be present. Hardened arteries may compress veins.

Grade 3: Exudative Phase

Blood leaks from damaged blood vessels and is further damaging the retina. Blood vessels may stop functioning. Areas of reduced blood flow may swell to create “cotton-wool” spots. 

Grade 4: Malignant Hypertension

Swelling occurs in the macula, which is the center of the retina, as well as in the optic nerve due to blood leaking from damaged blood vessels. This causes vision loss. 

At this stage, the condition can be difficult to manage, and systemic damage can be severe. Vision loss and/or retinal detachment may occur. 

Diagnosing Hypertensive Retinopathy

Ophthalmologists recommend having thorough annual eye examinations for hypertensive retinopathy to catch it early. This involves testing eye pressure and tests for sharpness and clarity of your vision (visual acuity).

To diagnose this condition, your eye doctor will also need to rule out conditions that look like hypertensive retinopathy, including these:

  • Diabetic retinopathy
  • Retinal venous obstruction
  • Hyperviscosity syndrome
  • Ocular ischemic syndrome
  • Radiation retinopathy

Typically, your eye doctor will look at your retina and photographs of the arteries and veins around your retina. They will assess your medical history of high blood pressure to determine whether you have hypertensive retinopathy or a different condition.

After that, get a physical examination involving lung exams, neurological/nervous system tests, and heart and blood vessels (cardiovascular) exams. Further, the ophthalmologist will check for other vital signs, and examine the back of your eye through a dilated-pupil fundus examination (DFE).

Examining the circulation of blood around the retina (fluorescein angiography) if you have a severe case of malignant hypertension will reveal enlargement of the venous end (microaneurysm formation), uneven drainage patterns in the wall of your eye (dendritic pattern in choroidal filling), and inefficient fluid delivery (capillary nonperfusion).

Later stages of hypertensive retinopathy show leaking of fluids.

Managing & Treating the Condition

Hypertensive retinopathy may not be preventable, but it is manageable as long as you control your blood pressure. Work with your physician to make lifestyle changes and take medication that can keep your blood pressure at a healthy level.

Keep your eye doctor up to date about your blood pressure, so they can monitor for hypertensive retinopathy. Symptoms might indicate that your blood pressure is not as well controlled as you think it is.

If you experience sudden dimming or loss of vision, you may be having a cardiac event like a heart attack or stroke. Your blood pressure could be extremely high. This is considered a medical emergency and requires immediate treatment in a hospital. Call 911.

As long as your blood pressure is managed, you can heal and recover much of your sight. People who develop Grade 4 hypertensive retinopathy will have permanent vision damage, but grades before that can still recover.

Lifestyle Changes

Lifestyle changes to improve your blood pressure include the following:

  • Eat a well-balanced, low-salt diet.
  • Limit how much alcohol you drink.
  • Get regular, moderate exercise.
  • Manage your stress levels.
  • Maintain a healthy weight.

You should always take medications for your blood pressure as prescribed by your doctor. There are no other treatments for hypertensive retinopathy.

How Many People Suffer From Hypertensive Retinopathy?

Among the American adult population, hypertensive retinopathy affects people of Chinese and African American descent the most. About 33 percent of U.S. adults have hypertension, with the condition only affecting 2 to 17 percent of people without diabetes.

In middle-aged adults younger than 45, hypertensive retinopathy is more prevalent among men. However, the situation flips among senior citizens. The condition affects more women than men older than 65.

A recent study found that hypertensive retinopathy affects 83 percent of hypertensive patients, with the highest prevalence being at earliest two of the four grades of the condition. Grade 1 has a 37 percent prevalence, followed by 17 percent at grade 2.

Researchers observed that kidney disease was the most influential factor for predicting chronic hypertensive retinopathy.

Hypertensive Retinopathy FAQs

Can hypertensive retinopathy be reversed?

Taking steps to lower blood pressure can help to halt the progression of hypertensive retinopathy, limit damage to the eye, and prevent vision loss. 

In cases of mild hypertensive retinopathy, effectively lowering blood pressure may heal some of the initial damage to the retina. In severe cases, some damage may be irreversible. However, addressing the issue is still important to prevent further damage and permanent vision loss.

Is hypertensive retinopathy permanent?

In advanced stages of the condition, some damage to the blood vessels and arteries in the eye may be irreversible. But avoiding total vision loss or further damage is possible with changes to lifestyle, maintaining a healthy diet, and taking medications in order to control and lower blood pressure. 

For those in the early stages of hypertensive retinopathy, these changes can allow for a reversal of some of the early effects.

Is hypertensive retinopathy an emergency?

In its later stages, hypertensive retinopathy requires emergency care as complete vision loss and retinal detachment are possible outcomes if blood pressure is not regulated.

In hypertension-related emergencies, such as a stroke, treating any vision-related problems quickly may help to prevent complete vision loss or permanent damage to the eye.

What is retinopathy hypertension?

Retinopathy hypertension is damage done to the blood vessels and arteries in the eye due to high and uncontrolled blood pressure.


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