What Is Hypertensive Retinopathy?

Did you know that high blood pressure (also called hypertension) can lead to vision loss? Managing hypertension is essential to avoiding a serious eye condition called hypertensive retinopathy, which results from damage to the blood vessels of the retina. Learn more about the symptoms of hypertensive retinopathy, stages of the condition, and how it's diagnosed and treated. 


Sally Wadyka

| Reviewed by

Quinn Wang

High blood pressure (also called hypertension) affects nearly 50 percent of adults (about 116 million) in the United States. High blood pressure is defined as systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg. Only about a quarter of those who have high blood pressure are able to keep their blood pressure well-controlled under 140/90. When your blood pressure is too high—and stays that way for prolonged periods of time—it can cause damage to blood vessels throughout the body. 

Over time, that damage can lead to an increased risk of heart attack, stroke, heart failure, kidney disease, sexual dysfunction and vision loss. Although all are serious conditions to be managed, we’re going to focus on how poorly controlled hypertension can cause vascular damage to the retina, a condition known as hypertensive retinopathy.

What is Hypertensive Retinopathy?

The retina is the paper-thin layer of light-sensing tissue that lines the back of the eye. The retina’s main job is to convert light into electrical signals, which it sends to the brain via the optic nerve. 

The retina relies on nutrients and oxygen from a network of tiny blood vessels, especially small arteries called arterioles. Uncontrolled high blood pressure harms these vessels, causing them to narrow and harden. This decreases overall blood flow to the retina, causing gradual tissue damage that can lead to chronic vision loss. 

These other eye conditions can also be caused by high blood pressure, and can occur along with hypertensive retinopathy:

  • Retinal vein occlusion (RVO) is similar to a stroke of the eye. Poor blood flow through the retinal vein(s) results in sudden vision loss that is sometimes irreversible.
  • Hypertensive choroidopathy is damage to the choroid, a layer of blood vessels and pigment that is located directly underneath the retina. This condition is more common in younger people (including pregnant women) who experience a sudden, dangerous increase in blood pressure. 
  • Ischemic optic neuropathy occurs when your optic nerve is damaged. High blood pressure can reduce or block blood flow to your optic nerve, leading to permanent vision loss.  

How Common is Hypertensive Retinopathy?

Up to 17 percent of people with high blood pressure—who don’t also have diabetes—experience hypertensive retinopathy. People with diabetes are at an increased risk of a similar condition, called diabetic retinopathy. Having hypertension and diabetes greatly increases your risk of vision loss, which means your eyecare should be managed carefully by an ophthalmologist or medically-trained optometrist.

Certain groups are at higher risk of hypertensive retinopathy. For instance, African Americans and those of Chinese descent are more likely to experience this condition. Additionally, age and gender can also affect risk. For individuals under 65, men are more at risk for hypertensive retinopathy, but for individuals over age 65, women are at increased risk. 

How Can I Prevent Hypertensive Retinopathy?

The best way to prevent hypertensive retinopathy is to control your blood pressure. If you have high blood pressure—or are at risk of the condition—you should take steps to manage it with the help of your primary care physician.

Changes that can lower your blood pressure and help keep it under control include:

  • Eating a heart-healthy diet that’s low in saturated fats, added sugar and sodium and high in fruits, vegetables and whole grains. 
  • Getting regular exercise
  • Maintaining a healthy weight 
  • Not smoking (or quitting if you do smoke)
  • Managing stress
  • Working with your doctor to determine if you also need to take medication to lower your blood pressure

What are the Symptoms of Hypertensive Retinopathy?

Although damage to your blood vessels builds over time, you may not notice any symptoms until the disease has progressed. The condition is graded on a scale of 1 to 4, depending on how much damage there has been to the vessels and the rest of the retina. At later stages, you may notice:

  • Narrowing of your visual field
  • Blurry vision
  • Loss of vision
  • Headaches

If you have high blood pressure and experience a sudden vision change or loss of vision, you should seek medical help immediately. 

How is Hypertensive Retinopathy Diagnosed?

During a comprehensive eye exam, your eyecare provider uses a special device called an ophthalmoscope. The device shines light into the back of the eye so that your provider can clearly see the blood vessels in the retina. This exam (also called a fundoscopic exam) allows them to look for signs of hypertensive retinopathy such as: 

  • compressed blood vessels (arteriovenous nicking,) 
  • blood on the surface of the retina (flame-shaped hemorrhages,)
  • yellow waste products (hard exudates,)
  • whitened areas of retinal tissue damage (cotton wool spots,) and
  • swelling of the optic nerve head (optic disc edema.) 

How is Hypertensive Retinopathy Treated?

The primary treatment for hypertensive retinopathy is treating high blood pressure. Work with your doctor on lifestyle changes you can make and medication that can help you effectively manage your blood pressure. If you experience vision loss, it may be possible to treat the retinal edema with laser or an injection to the back of the eye with corticosteroids or antivascular endothelial growth factor drugs such as ranibizumab, pegaptanib, bevacizumab. 

What are the Outcomes for People with Hypertensive Retinopathy?

Living with uncontrolled high blood pressure increases your risk of numerous health conditions. If you have hypertensive retinopathy, you also have an increased risk of stroke and heart attack. 

Damage already done to the retina cannot be reversed. But by getting your blood pressure under control—especially if you are still in an early stage of hypertensive retinopathy—you can save your vision. 


Merck Manual

American Heart Association

American Academy of Ophthalmology



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The jury is still out on how effective blue light glasses are for eyestrain. One recent study found they made no difference in eyestrain symptoms during a two-hour-long computer task. But some experts feel they may help alleviate eyestrain and fatigue during prolonged, cumulative screen time. Either way, blue glasses alone won’t solve the problem of too much screen time. The best way to reduce eyestrain is to limit screen time and take frequent breaks when you do need to spend several hours at your computer. 

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