Hypertension and the Eyes

Submitted by Anonymous (not verified) on Mon, 09/28/2020 - 16:09
Elderly man examined by an ophthalmologist, hypertension or high blood pressure exam from eye doctor

Hypertension is also known as high blood pressure and can lead to increased risk of heart disease, stroke, and aneurysms. Hypertension usually does not have any symptoms unless it is severe. The American Heart Association has classified normal blood pressure of systolic less than 120 and diastolic less than 80. Any readings above normal are classified as elevated, high blood pressure (BP) stage 1, high BP stage 2, hypertensive crisis. Below are the blood pressure categories from American Heart Association.

How Hypertension Impacts Your Eyes

When blood pressure stays continuously high over a long period of time, it can cause changes to the blood vessels, and those changes can be seen in the back of the eye upon dilation exam or on retinal photos.

In the early stage of hypertensive retinopathy you can start to see changes to the vessels in the back of the eye. These changes can be seen as diffuse narrowing of the arteries and changes to the vessel color. As hypertensive changes progress the arterioles can appear more opaque which means blood flow is reduced to that area.

Hypertensive retinopathy can be classified as mild, moderate, and severe. Mild changes include vascular changes like generalized arteriolar narrowing and constriction of blood vessels. 


Moderate stage includes arteriole changes plus retinal changes like bleeding in the back of the eye, exudates which is vessel leakage, and cotton wool spots which is infarct tissue due to blockage of an arterioles.

Severe stage includes all changes mentioned in mild and moderate stages and optic nerve swelling. Optic nerve swelling causes the nerve edges to appear blurred and indistinct and also may appear elevated. This stage is a medical emergency because there is end organ damage occurring. End organ damage is damage to major organs in the circulatory system like the eyes, brain, heart and kidney due to uncontrolled blood pressure. If this is seen it is important to seek medical attention immediately because if end organ damage is seen in the eye it is most likely occurring in other parts of the body.

Hypertensive retinopathy can lead to various complications like artery occlusions, vein occlusions, macroaneurysms, and macular edema that can affect the vision and can have long term consequences.

If you have hypertension it's important to get annual eye exams to check for high blood pressure changes in your eyes. It is also important to control your blood pressures and follow up with your primary care provider to manage your high blood pressure.