Hypertensive retinopathy


Hypertensive retinopathy

What is it?

It is the set of ocular manifestations that occurs in the retina as a consequence of hypertension. The higher the blood pressure and the longer time it stays at high levels, the more probability of having more severe ocular damage. Gravity also depends on the previous state of the retinal vascular tree, and the rapid onset of hypertension. There are other associated factors that can aggravate hypertensive retinopathy, such as: atherosclerosis, advanced age, diabetes, etc ...

The chronic increase in blood pressure causes damage to the retinal vessels and tissues that surround them. The two fundamental changes occurring are increased vascular permeability, which can lead to retinal edema (swelling of the retina), and focal or generalized narrowing of the retinal vessels with the risk involved ischemia (lack of blood supply).


The degree of damage to the retina is graded on a scale of I to IV (Keith-Wagener-Barker classification). Grade I often produces no symptoms, while grade IV may involve inflammation of the optic nerve and the center of the retina; the macula, with severe consequences on vision. We distinguish between: chronic hypertensive retinopathy from mild to moderate, in which patients are generally asymptomatic and it is usually detected by chance after ophthalmoscope examination, and longstanding retinopathy with severe hypertension, where patients often complain of blurred vision or even severe vision loss.

There is acute hypertensive retinopathy, also called malignant or accelerated, which has a sudden onset and is characterized by high pressures, often accompanied by severe headaches. In this case the damage to the retina and optic nerve is important, and its impact on vision is potentially severe.


There is no specific treatment for hypertensive retinopathy; it consists mainly on strictly controlling and maintaining one’s blood pressure. Although some patients with grade IV might have permanent damage and visual defects, in general, a downfall in blood pressure can lead to a significant resolution for retinal damage.


The importance of having an examination of the fundus in hypertension patients, age and the presence of other cardiovascular risk factors makes it necessary to follow periodic monitoring from an ophthalmologist, for an examination of the fundus under pupillary dilation.