The retina is one of the “target organs” that are damaged by sustained hypertension. Subjected to excessively high blood pressure over prolonged time, the small blood vessels that involve the eye are damaged, thickening, bulging and leaking.

Early signs of retinopathy correlate less well with mortality and morbidity than used to be thought, but signs of accelerated or “malignant” hypertension indicate severe illness.

Most patients with hypertensive retinopathy present without visual symptoms, however, some may report decreased vision or headaches.

Signs of damage to the retina caused by hypertension include:

• Arteriosclerotic changes
  • Arteriolar narrowing that is almost always bilateral
    • Grade I – 3/4 normal caliber
    • Grade II – 1/2 normal caliber
    • Grade III – 1/3 normal caliber
    • Grade IV – thread-like or invisible
  • Arterio-venous crossing changes (aka “AV nicking”) with venous constriction and banking
  • Arteriolar color changes
    • Copper wire arterioles are those arterioles in which the central light reflex occupies most of the width.
    • Silver wire arterioles are those in which the central light reflex occupies all of the width of the arteriole.
  • Vessel sclerosis
• Ischemic changes (e.g. “cotton wool spots“)
• Hemorrhages, often flame shaped.
• Edema
  • Ring of exudates around the retina called a “macular star”
• Papilledema, or optic disc edema, in patients with malignant hypertension
• Visual acuity loss, typically due to macular involvement

• Fluorescein angiography
• Ophthalmoscopy
• Sphygmomanometry

A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient’s high blood pressure. The eye is an organ where damage is easily visible at an early stage, so regular eye examinations are important.

• Hypertensive crisis
• List of eye diseases and disorders
• List of systemic diseases with ocular manifestations
• Ophthalmology
• Optometry

• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, J.B. Lippincott, 1994.
• Hypertensive retinopathy

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