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Hypertensive Retinopathy

by Sunir J. Garg, MD, FACS

Hypertensive retinopathy is damage to the retina (the transparent, light-sensitive structure at the back of the eye) caused by high blood pressure.

When blood pressure is high (hypertension— High Blood Pressure), the retina may become damaged. Hypertension damages the small blood vessels in the retina, causing their walls to thicken, which decreases the amount of blood that can flow through them. As a result, the blood supply to the retina is reduced. Patches of the retina may become damaged because the blood supply is inadequate. As hypertensive retinopathy progresses, blood may leak into the retina. These changes lead to a gradual loss of vision, particularly if they affect the macula, the central part of the retina. Even mild hypertension may damage the retinal blood vessels if it goes untreated for years.

Using an ophthalmoscope, doctors can observe the typical appearance of the retina in people with high blood pressure. The amount of damage to the retinal blood vessels tends to correlate with the amount of damage to blood vessels in other organs affected by hypertension, such as the brain, heart, and kidneys. When blood pressure is extremely high, doctors may be able to see other changes in the eye, such as swelling of the front of the optic nerve.

Did You Know...

  • The eye is the only organ in the body where doctors can routinely directly observe arteries and deep veins (by using an ophthalmoscope). The appearance of these blood vessels can tell doctors how hypertension and atherosclerosis have affected other blood vessels in the body.

The goal of treatment is to lower blood pressure long term. If vision loss occurs, swelling in the retina can be treated with a laser, by injecting corticosteroids, by putting a dexamethasone (a corticosteroid) implant in the eye, or by injecting certain other drugs (for example, ranibizumab, pegaptanib, aflibercept, or bevacizumab) into the eye. Rarely, when high blood pressure is severe and life threatening, treatment may be needed immediately to save vision and avoid other complications, including stroke, heart failure, kidney failure, and heart attack.

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