Hypertension may lead to multiple adverse effects to the eye that can inevitably cause retinopathy, optic neuropathy, and choroidopathy. It can cause occlusion of major retinal vessels such as retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Hypertensive retinopathy is retinal vascular damage caused by hypertension and is the most common ocular presentation of hypertension.
What are the Risk Factors for Hypertensive Retinopathy?
- High salt diet
- Obesity
- Tobacco use
- Alcohol
- Family history
- Stress
- Ethnic background
Color fundus photo of a patient with hypertensive retinopathy showing tortuous arterioles, retinal hemorrhages, and cotton wool spots.What are the Signs & Symptoms of Hypertensive Retinopathy:
Funduscopic examination can reveal arteriolar constriction and tortuosity, arteriovenous nicking, vascular wall changes, flame-shaped hemorrhages, microaneurysms, cotton-wool spots, yellow hard exudates, retinal and optic disk edema, or a combination of these signs.
Chronic changes from chronic hypertension will not cause any symptoms alone but patients often experience decreased vision and develop complications that lead to the typical symptoms of vascular occlusions or macroaneurysms. Only acute malignant hypertension will cause eye pain, headaches, or reduced visual acuity.
How is Hypertensive Retinopathy Diagnosed?
Hypertensive retinopathy is diagnosed based upon its clinical appearance on dilated fundoscopic exam and coexistent hypertension. Fluorescein angiography (FA) can demonstrate retinal capillary microaneurysm formation, nonperfusion, and leakage. Optical coherence tomography (OCT) shows the presence of retinal edema and subretinal fluid.
How is Hypertensive Retinopathy Treated?
There is an association between the grade of retinopathy and mortality. The treatment for hypertensive retinopathy is primarily focused upon reducing blood pressure. It is important to work together with the primary care physician to reduce ocular and systemic damage.