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Hypertensive retinopathy: Eye disease due to high blood pressure

Hypertension, the medical term for high blood pressure, can lead to several harmful eye conditions, such as hypertensive retinopathy, optic neuropathy and hypertensive choroidopathy. Hypertensive retinopathy is the most common eye condition caused by high blood pressure. This causes damage to the retina. The retina is the layer of tissue at the back of the eye. It converts the light and images that the eye receives into nerve signals that go to the brain. Double vision and vision loss are some symptoms of hypertensive retinopathy. The condition can be treated with medication in combination with a healthy lifestyle. It is important that the patient adheres to the treatment because various eye and other complications are possible.

  • Epidemiology of hypertensive retinopathy
  • Causes: Eye disease due to high blood pressure
  • Risk factors for eye disease
  • Symptoms
  • Diagnosis: Damage to small blood vessels in the retina
  • Hypertension treatment: Medication and lifestyle
  • Complications
  • Prognosis


Epidemiology of hypertensive retinopathy

The condition is more common in patients of African descent, especially Afro-Caribbean patients. Furthermore, women are affected more often than men.

Causes: Eye disease due to high blood pressure

Hypertension damages the small blood vessels in the retina (retinopathy), causing the walls to thicken and blood flow to decrease. The retina also receives less blood, causing damage to parts of the retina. When hypertensive retinopathy progresses, blood leaks into the retina (medical term: retina). These changes lead to a gradual loss of vision, especially if the blood affects the macula (the central part of the retina). Even mild hypertension damages retinal blood vessels if left untreated for years.

Risk factors for eye disease

Patients are at higher risk of retinal damage and vision loss in the following conditions:

  • atherosclerosis (hardening of the arteries)
  • diabetes mellitus
  • a heart condition
  • high cholesterol
  • long-term high blood pressure the influence of high blood pressure on the eyes
  • eating an unhealthy diet
  • overweight (obesity)
  • excessive use of alcohol
  • Smoking: Smoking has a detrimental effect on vision.



Most patients with hypertensive retinopathy have no symptoms. These only occur at a late stage of the disease. Symptoms include double vision (diplopia), reduced visual acuity, eye pain, vision loss and headache. Sudden symptoms are a medical emergency.Headache and vision loss occur in hypertensive retinopathy / Source: Geralt, Pixabay

Diagnosis: Damage to small blood vessels in the retina

Eye examination

The doctor detects high blood pressure in the patient. An ophthalmologist also performs an eye examination using an ophthalmoscope (ophthalmoscopy). This allows him to identify the typical appearance of the retina in patients with high blood pressure. He also looks for images of the narrowing of the blood vessels (vasoconstriction) and signs that fluid has leaked from the blood vessels. When blood pressure is extremely high, the ophthalmologist will notice swelling of the optic nerve (pimple). This situation requires immediate medical treatment. The doctor will further perform a fluorescein angiography to examine the blood vessels and confirm the diagnosis.

Differential diagnosis

The doctor sometimes finds it difficult to know the difference between hypertensive retinopathy and diabetic retinopathy. Other conditions that can be classified as differential diagnoses include radiation retinopathy, anemia (anemia: lack of red blood cells), Eales disease (peripheral vascular disease in the eye), ocular infarction (occlusion of blood vessels in the retina) and retinal vein occlusion (blockage of retinal blood vessels).

Hypertension treatment: Medication and lifestyle

The ophthalmologist wants to lower blood pressure in the long term. This is done by medicines such as ACE inhibitors, calcium channel blockers and diuretics (water pills). Furthermore, the patient follows a healthy lifestyle (no smoking, limited alcohol consumption, sufficient physical activities, a healthy and balanced diet, a healthy weight and a lifestyle that is not too stressful). In rare cases, immediate treatment is needed to save vision and also to prevent other complications.



Hypertension retinopathy also leads to the following eye complications:

  • a severe loss of visual acuity
  • a swollen optic nerve (optic nerve)
  • a vitreous hemorrhage (sudden loss of vision)
  • a retinal detachment
  • an eye infarction (occlusion of blood vessels in the retina)
  • macular edema (swelling of the macula, the central part of the retina)
  • neovascularization (new vessel formation in the eye)
  • optic nerve atrophy
  • retinal arterial macroaneurysm
  • retinal arterial occlusion or retinal vein occlusion
  • worsening of diabetic retinopathy



When the retinal blood vessels are seriously affected, this leads to the following complications:

  • congestive heart failure (poor pumping of blood through the heart)
  • death
  • a stroke (in a stroke there is insufficient blood flow to the brain, resulting in both mental and physical symptoms)
  • a heart attack
  • kidney failure



The amount of damage to the retinal blood vessels correlates with the degree of damage to blood vessels in other organs affected by hypertension, such as the brain, heart and kidneys. In other words, the higher the blood pressure is and the longer it has been that way, the more serious the damage is. When the patient’s blood pressure is controlled, and only mild changes have occurred in the blood vessels and other parts of the retina, the retina heals. Sometimes the patient has severe symptoms due to macular edema in combination with a swollen optic nerve. In this case, the macula or optic nerve is permanently damaged.

read more

  • The influence of high blood pressure on the eyes
  • Hypertension (increased blood pressure): Types and symptoms
  • Retinopathy: Damage to the retina of the eye or eyes
  • High blood pressure (hypertension): Causes and treatment
  • Retina: Conditions and problems with the retina in the eye