Hypertensive Retinopathy: Causes, Symptoms, Stages, and Home Remedies

Close-up of a female doctor examining a patientVision loss may seem like something that occurs naturally when you age, but this isn’t always the case. There are many other contributing factors that can harm our vision — and controlling these issues can protect our vision even in our old age.

You’re probably familiar with vision loss associated with diabetes, but there’s another health condition that can affect our vision — it’s hypertension. That’s right, our blood pressure can greatly affect our vision and lead to hypertensive retinopathy.


To understand what hypertensive retinopathy is, it’s important to start with retinopathy. Retinopathy is an eye condition that causes damage to the retina — the part of the eye that senses light — and can lead to partial or complete vision loss.

Hypertensive retinopathy then is a type of retinopathy caused by hypertension. High blood pressure causes damage to the blood vessels, which can occur anywhere in the body and can lead to heart problems. Bleeding, blockages, and thickening of the arteries within the eyes may ultimately affect our vision.

Causes and Risk Factors of Hypertensive Retinopathy

As we mentioned, hypertensive retinopathy is brought on by the effects of chronic high blood pressure, so the causes are similar for the two conditions. Some of the common causes are:

  • Lack of activity
  • Smoking
  • Stress
  • Poor diet

Hypertensive retinopathy is most common among the elderly who have uncontrolled hypertension.

Risk factors for hypertensive retinopathy include having chronic hypertension, having a systemic blood pressure of 140/110 mmHg for advanced stages, or having a systemic blood pressure of 180/120 mmHg for the malignant stage.

Having a risk factor doesn’t necessarily mean you’ll develop hypertensive retinopathy, but it does suggest your risk is higher compared to a person without such factors.

Difference between Diabetic Retinopathy and Hypertensive Retinopathy

Diabetes can also lead to retinopathy, but there are some differences to take note of.

In hypertensive retinopathy, the blood vessels become damaged and may bleed. In diabetic retinopathy, the vessels actually deteriorate. Fluid can then collect in the retina leading to swelling, which affects the sharpness of vision.

Also, in diabetic retinopathy, blood vessels may grow on the surface of the retina, causing bleeding. These vessels are unstable, whereas in hypertensive retinopathy, although the vessels may become damaged, they do not move.

Lastly, the retina in diabetic retinopathy may separate and a gel can form between the lens and retina, leading to bleeding and blocking vision. Not to say that diabetic retinopathy is more severe than hypertensive retinopathy, but as you can tell, much damage can occur to the eye as a whole.

Symptoms of Hypertensive Retinopathy

Similar to hypertension, hypertensive retinopathy symptoms are minimal. The only symptom people may notice is blurry vision, but unfortunately, by that point, permanent damage may have set in. If you notice changes to your vision, this is a result of very high blood pressure, so seeking medical attention is advised.

Other symptoms you may notice include eye swelling, bursting of a blood vessel in the eye causing redness, and double vision, which is accompanied by a headache.

Grades of Hypertensive Retinopathy

Hypertensive retinopathy symptoms depend on the grading, which comes in four levels, ranging from mild to severe.

Hypertensive Retinopathy Grading 1: In this grade, the arterioles become thicker.

Hypertensive Retinopathy Grading 2: The veins begin to constrict and frontal arteriolar spasms occur. Minimal symptoms associated with this grading can be seen as normal hypertension symptoms.

Hypertensive Retinopathy Grading 3: Fat deposits occur within the eye, as does hemorrhages and ischemia. One may also experience headaches, vertigo, and nervousness. Blood pressure is high in this grading.

Hypertensive Retinopathy Grading 4: This type is characterized by papilledema, which is the swelling of the optic disc. You may experience weight loss, have elevated blood pressure, headaches, and heart problems.

Hypertensive Retinopathy Complications

If left untreated, complications can arise. These complications include:

  • Ischemic optic neuropathy, where blood flow to the eye becomes disrupted as a result of high blood pressure and causes damage to the optic nerve.
  • Retinal artery occlusion, where a blood clot occurs in the arteries responsible for carrying blood to the retina. Vision loss can occur if the retina can’t get enough oxygenated blood.
  • Retinal vein occlusion, where the veins that carry blood away from the eye to become filtered become blocked and a clot occurs.
  • Nerve fiber layer ischemia, where the nerves become damaged, which leads to cotton-wool spots (white lesions) on the retina.
  • Malignant hypertension, although rare, can lead to a sudden increase in blood pressure, which can lead to sudden vision loss and can be life-threatening.
  • There is a higher risk of stroke or heart attack among patients with hypertensive retinopathy.

How to Diagnose Hypertensive Retinopathy

Your doctor must first perform a physical examination on you by checking your heart health, lung health, performing a neurological exam, and checking other vital signs to rule out any other medical condition that could be causing your symptoms and health problems.

Your doctor can also perform diagnostic tests like ophthalmoscope and fluorescein angiography. For the ophthalmoscope, your doctor exams your retina by shining a light through the pupil to see the back of the eye to determine if there are any narrowing blood vessels or fluid leaking. This is a quick and painless test.

Fluorescein angiography examines retinal blood flow where your doctor puts drops in your eyes to dilate pupils and take a picture. After the first round of pictures is done, your doctor injects a dye into a vein and then proceeds to take more pictures once the dye reaches the eyes.

Home Remedies to Prevent Hypertensive Retinopathy

As you can see, hypertensive retinopathy can be quite serious and result in complete vision loss, so preventing its onset is vital to maintain healthy vision. The secret then to preventing hypertensive retinopathy is to monitor and manage blood pressure.

Some effective tips to prevent hypertensive retinopathy and maintain healthy blood pressure are as follows:

  • Exercise regularly: Know your capabilities and create an exercise plan best suited to your abilities. Even 10 minutes can begin to help lower blood pressure
  • Eat well: Avoid processed foods and foods with high amounts of salt and sugar, minimize trans fats, and eat whole foods to benefit the entire body
  • Keep a healthy body weight: Being overweight can contribute to high blood pressure. By exercising and eating well, you can maintain a healthy weight and ensure your blood pressure stays healthy
  • Monitor your health: Keeping track of your blood pressure is easy and can be done at home as long as you have the device. Monitoring your blood pressure will allow you to catch problems early on and make appropriate changes
  • Follow directions on medications: If your doctor has you on medications for your blood pressure, ensure you are taking these as directed. Misuse of medications will diminish their effectiveness and lead to further problems

Prognosis of Hypertensive Retinopathy

Prognosis for hypertensive retinopathy is worse among those patients with severe hypertensive retinopathy. Patients with stage three or higher are at a higher risk of stroke or heart attack, congestive heart failure, and even death.


Patients with uncontrolled hypertension — and those in stage four — generally have a poor prognosis for survival.

Structural changes to arteries cannot be reversed and even when treated, these patients have a higher risk for retinal artery and vein occlusions as well as other complications.

Our bodies are so connected that even if one aspect of our health changes for the worse, it can lead to greater problems elsewhere. This is how hypertensive retinopathy comes about, as blood pressure that is unmanaged affects our eyes. Maintaining overall good health is vital for maintaining proper function of the body.



Related Reading:

Age-related vision changes: Presbyopia, cataracts, AMD, glaucoma, diabetic retinopathy

Diastolic high blood pressure (hypertension): Causes, symptoms, and treatment