Suffering from high blood pressure over a long period of time can cause adverse changes in the retina. This is one of those chronic conditions often first diagnosed by your optometrist during a routine eye examination. It’s called a “silent killer” because it usually has no symptoms. Hypertension or high blood pressure can exist for a long period of time without the sufferer being aware of it. Yet, if undetected, it can cause serious changes in the retina which may ultimately affect your vision. Patients with hypertensive retinopathy are at high risk of hypertensive damage to other end organs.


Diagnosis of Hypertensive retinopathy is easy and will be picked up by your optometrist on a routine eye examination when performing ophthalmoscopy. Photos are usually taken to aid diagnosis and to keep a baseline record to monitor the disease going forward.

When your blood pressure is too high, the retina’s blood vessel walls may thicken. This may cause your blood vessels to become narrow, which then restricts blood from reaching the retina. In some cases, the retina becomes swollen. Over time, high blood pressure can cause damage to the retina’s blood vessels, limit the retina’s function, and put pressure on the optic nerve, causing vision problems. Signs usually develop late in the disease. Funduscopic examination (inside the back of the eye), shows arteriolar constriction, arteriovenous nicking, vascular wall changes, flame-shaped haemorrhages, cotton-wool spots, yellow hard exudates, and optic disk oedema. Treatment is directed at controlling blood pressure and, when vision loss occurs, treating the retina.

Hypertensive Retinopathy (Cotton Wool Spots) PAUL PARKER/SCIENCE PHOTO LIBRARY

Your blood pressure levels can be affected by:

  • a lack of physical activity
  • being overweight
  • eating too much salt
  • a stressful lifestyle
  • smoking

The following conditions put you at a higher risk for Hypertensive Retinopathy:

  • prolonged high blood pressure
  • heart disease
  • atherosclerosis
  • diabetes
  • smoking
  • high cholesterol
  • being overweight
  • eating an unhealthy diet
  • heavy alcohol consumption


Hypertensive retinopathy is managed primarily by controlling blood pressure. However, if there are more advanced retinal changes, your optometrist will refer you for an assessment by an ophthalmologist.

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