Hypertensive retinopathy

Changes in the blood vessels of the retina caused by high blood pressure.

Symptoms

• Usually no symptoms
• With very high blood pressure: blurred vision, often with headache
• Sudden loss of vision in one eye may point to a blocked vessel

How it develops

Long-term high blood pressure makes the artery walls thicker and stiffer. They narrow and press on the veins where they cross. With very high pressure the vessels leak and the optic nerve can swell. Smoking, diabetes and high cholesterol add to the damage.

Forms and stages

• Grade 1: the arteries are slightly narrower throughout.
• Grade 2: local narrowing, and veins pressed in where an artery crosses.
• Grade 3: also small bleeds, white cotton-wool spots and fatty deposits.
• Grade 4: also a swollen optic nerve; this is an emergency.

Treatment

• Lowering and controlling blood pressure via your GP or internist.
• Grades 1 and 2 need no eye treatment.
• In grades 3 and 4 blood pressure must come down quickly but in a controlled way, often in hospital.
• Bleeds and swelling usually disappear within weeks to months once blood pressure is well controlled.

This page is a short summary and does not replace a consultation. Want to know how the eye works? See The eye.