Hypertensive retinopathy

Hypertensive retinopathy involves damage to the retina caused by high blood pressure.

Causes, incidence, and risk factors

High blood pressure can cause damage to blood vessels in the eyes. The higher the blood pressure and the longer it has been elevated, the more severe the damage is likely to be.

Your health care provider can see narrowing of blood vessels and excess fluid oozing from blood vessels with the ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of I to IV.

At grade I, no symptoms may be present. Grade IV hypertensive retinopathy includes swelling of the optic nerve and visual center of the retina (macula), which can cause decreased vision.


  • Headaches  
  • Visual disturbances

Signs and tests

  • Ophthalmoscopic examination  
  • Fluorescein angiography  
  • Blood pressure


Control of high blood pressure (hypertension) is the only treatment for hypertensive retinopathy.

Expectations (prognosis)

Patients with grade IV or severe hypertensive retinopathy frequently have associated cardiac and renal (kidney) complications of high blood pressure. The retina will generally recover well if the blood pressure is controlled, but some patients with grade IV hypertensive retinopathy will have permanent damage to the optic nerve or macula.


  • Complications associated with high blood pressure  
  • Irreversible visual impairment or damage to the optic nerve or macula

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have high blood pressure and vision changes or headaches occur.

Control of high blood pressure prevents changes in the blood vessels of the eye.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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