Hypertensive retinopathy

Answer 1

Definition

Hypertensive retinopathy is damage to the back part of the eye (retina) caused by high blood pressure.

Causes, incidence, and risk factors

High blood pressure can cause damage to blood vessels in the eyes. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be.

Your health care provider can see narrowing of blood vessels, and excess fluid oozing from blood vessels, with an instrument called an ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of 1 to 4.

At grade 1, no symptoms may be present. Grade 4 hypertensive retinopathy includes swelling of the optic nerve and of the visual center of the retina (macula). Such swelling can cause decreased vision.

Other retinopathies that are known complications of high blood pressure are called:

• diabetic retinopathy
• ischemic optic neuropathy
• retinal artery occlusion
• retinal emboli
• retinal microaneurysm
• retinal vein occlusion

Symptoms

• Headaches
• Visual disturbances, and sometimes sudden vision loss

Signs and tests

• Blood pressure
• Fluorescein angiography
• Ophthalmoscopic examination, which can show changes even if you have no symptoms

Treatment

Control of high blood pressure (hypertension) is the only treatment for hypertensive retinopathy.

Expectations (prognosis)

Patients with grade 4 (severe hypertensive retinopathy) frequently also have heart and kidney complications of high blood pressure. The retina will generally recover well if the blood pressure is controlled, but some patients with grade 4 hypertensive retinopathy will have permanent damage to the optic nerve or macula.

Complications

• Complications associated with high blood pressure
• Irreversible damage to the optic nerve or macula, resulting in vision problems

Calling your health care provider

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.

Prevention

Control of high blood pressure prevents changes in the blood vessels of the eye.

ReferencesKlig JE. Ophthalmologic complications of systemic disease.Emerg Med Clin North Am.2008;26(1):217-231.

Answer 2

Definition

Hypertensive retinopathy is damage to theretina 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.

See also: Diabetic retinopathy

Causes, incidence, and risk factors

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, a condition called malignant hypertensiondevelops. 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:

• Ischemic optic neuropathy -- damage to the nerves in the eye due to poor blood flow
• Retinal artery occlusion -- blockage of the blood supply in the arteries to the retina
• Retinal vein occlusion

Symptoms

Most people with hypertensive retinopathy do not have symptoms until late in the disease.

Malignant hypertension may cause the following sudden symptoms, and should be considered a medical emergency:

• Double vision or dim vision
• Headaches
• Visual disturbances, and sometimes sudden vision loss

Signs 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 retina damage (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, areas where blood vessels have leaked, and other parts of the retina.
• Grade 4 hypertensive 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 (hypertension) is the only treatment for hypertensive retinopathy.

See also: Malignant hypertension for treatment of this disorder

Expectations (prognosis)

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

Complications

• Complications associated with high blood pressure
• Irreversible damage to the optic nerve or macula, resulting in vision problems

Calling your health care provider

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.

Prevention

Controlling high blood pressure prevents changes in the blood vessels of the eye, as well as in other organs like the heart, kidneys, and brain.

References

Kovach JL, Schwartz SG, Schneider S, Rosen RB. Systemic hypertension and the eye. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2009:chap 13.

Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. 2008;26(1):217-231.

Rogers AH. Hypertensive retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis mo: Mosby Elsevier;2008:chap 6.15.

Reviewed By

Review Date: 08/31/2010

Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.