[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Hypertensive retinopathy [Conditions](https://durgical.com/en/conditions/) · [Ophthalmology and ENT](https://durgical.com/en/conditions/) # Hypertensive retinopathy Hypertensive retinopathy is damage to the small vessels of the [retina](https://durgical.com/en/anatomy/retina/) caused by high blood pressure. It is a window on damage to the heart, brain and kidneys. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Retina](https://durgical.com/en/anatomy/retina/) - [Central retinal artery](https://durgical.com/en/anatomy/central-retinal-artery/) - [Optic disc](https://durgical.com/en/anatomy/optic-disc/) - [Macula](https://durgical.com/en/anatomy/macula/) - [Ophthalmic veins](https://durgical.com/en/anatomy/superior-ophthalmic-vein/) ## Why it happens - [Physiology of hypertension](https://durgical.com/en/physiology/physiology-of-hypertension/) - [Blood vessels: artery, vein and capillary layers](https://durgical.com/en/histology/blood-vessels-artery-vein-and-capillary-layers/) - [Retina: the ten layers, rods and cones](https://durgical.com/en/histology/retina-the-ten-layers-rods-and-cones/) ## What it is Changes in the retinal arterioles and retina caused by high blood pressure, ranging from silent narrowing of the vessels to bleeding, retinal ischaemia and [optic disc](https://durgical.com/en/anatomy/optic-disc/) swelling in a hypertensive emergency. ## Who gets it Common wherever hypertension is common; hypertension is one of the leading chronic diseases in Colombia and Latin America, often poorly controlled. Retinal signs are found in a large share of adults with long-standing hypertension, usually without symptoms. ## Causes - Chronic arterial hypertension (essential or secondary) - Acute severe rise in blood pressure (hypertensive emergency, malignant hypertension) - Preeclampsia and eclampsia; renal disease causing secondary hypertension ## Risk factors - Long duration and poor control of hypertension - Diabetes, dyslipidaemia and smoking - Chronic kidney disease - Older age; people of African ancestry have higher rates ## Pathophysiology High pressure first makes the arterioles constrict (narrowing). With time the vessel walls thicken and harden (arteriolosclerosis), producing a brighter light reflex (copper and silver wiring) and compression of veins where arteries cross them (AV nicking). In severe or acute hypertension the blood–retina barrier breaks down: flame haemorrhages, hard exudates, cotton-wool spots (nerve fibre layer infarcts) and, finally, optic disc swelling. ## Classification - Keith–Wagener–Barker grades 1–4: 1 arteriolar narrowing; 2 plus AV nicking; 3 plus haemorrhages, exudates and cotton-wool spots; 4 plus optic disc swelling - Wong–Mitchell: mild (narrowing, AV nicking, copper wiring), moderate (haemorrhages, microaneurysms, cotton-wool spots, exudates), severe (moderate plus disc swelling) ## Symptoms and signs - Usually none; found on fundoscopy - Blurred or reduced vision when the [macula](https://durgical.com/en/anatomy/macula/) or optic disc is affected - Headache and visual disturbance in hypertensive emergency ## Red flags - Optic disc swelling with very high blood pressure (hypertensive emergency with end-organ damage) - Sudden vision loss, which may signal retinal vein or artery occlusion - Headache, confusion, [chest](https://durgical.com/en/anatomy/region/chest/) pain, dyspnoea or reduced urine output with high blood pressure - Visual symptoms or headache in a pregnant woman (possible severe preeclampsia) ## Diagnosis **Clinical** Blood pressure measurement and fundoscopy (direct ophthalmoscope or dilated examination), looking for narrowing, AV nicking, haemorrhages, exudates, cotton-wool spots and disc swelling. Assess other target organs. **Tests** Creatinine and urinalysis ([kidney](https://durgical.com/en/anatomy/kidney/) damage), electrolytes, glucose and lipids, ECG for left ventricular hypertrophy; tests for secondary hypertension in young or resistant cases. **Imaging** Fundus photography documents changes; optical coherence tomography for macular oedema; echocardiography or brain imaging when other organ damage is suspected. ## Differential diagnosis - Diabetic retinopathy - Central or branch retinal vein occlusion - Papilloedema from raised intracranial pressure - Radiation retinopathy - Retinopathy of anaemia, leukaemia or HIV ## Goal of treatment Control blood pressure (gradually in an emergency) to protect the retina, heart, brain and kidneys; the eye itself needs little specific treatment. ## Treatment **Medical** Long-term antihypertensive therapy: ACE inhibitors or ARBs, calcium-channel blockers and thiazide-type diuretics are the main classes. **Acute** Hypertensive emergency: admission, intravenous antihypertensives and controlled lowering of pressure over hours, avoiding a sudden drop that could cause ischaemia of the [optic nerve](https://durgical.com/en/anatomy/optic-nerve/) or brain. **Lifestyle** Less salt, weight control, regular activity, limited alcohol and no smoking; control of diabetes and lipids. **Follow-up** Repeat fundoscopy, blood pressure follow-up and screening for kidney and heart damage. ## Complications - Retinal vein and artery occlusion - Macular oedema and permanent vision loss - Ischaemic optic neuropathy - Marker of higher risk of stroke, heart disease and kidney failure ## Prognosis Most early changes stabilise and haemorrhages and exudates resolve once blood pressure is controlled, although arteriolar sclerosis does not reverse. Severe retinopathy can leave permanent optic nerve or macular damage and indicates a high cardiovascular and renal risk. ## Prevention - Screening and sustained control of hypertension - Fundoscopy as part of the assessment of target-organ damage ## Test yourself Think of the answer, then tap the question to see it. ## Which fundus finding defines grade 4 Keith–Wagener–Barker hypertensive retinopathy? Optic disc swelling (papilloedema) on top of the haemorrhages, exudates and cotton-wool spots of grade 3. ## What is a cotton-wool spot? A small infarct of the retinal nerve fibre layer, seen as a fluffy white patch, caused by arteriolar occlusion. ## What is AV nicking? Compression of a retinal vein where a thickened, sclerotic arteriole crosses it, a sign of chronic hypertension. ## What is the main treatment of hypertensive retinopathy? Controlling blood pressure; in an emergency it is lowered gradually rather than abruptly. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/hypertensive-retinopathy/) ## Related conditions - [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/) - [Hypertensive emergency and urgency](https://durgical.com/en/conditions/hypertensive-emergency-and-urgency/) - [Hypertensive heart disease](https://durgical.com/en/conditions/hypertensive-heart-disease/) - [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/) - [Diabetic retinopathy](https://durgical.com/en/conditions/diabetic-retinopathy/) - [Preeclampsia](https://durgical.com/en/conditions/preeclampsia/) - [Central retinal vein occlusion](https://durgical.com/en/conditions/central-retinal-vein-occlusion/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [High blood pressure and eye disease: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000999.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [Hypertensive Retinopathy](https://eyewiki.org/Hypertensive_Retinopathy) (EyeWiki (American Academy of Ophthalmology), 2025). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/hypertensive-retinopathy/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/hypertensive-retinopathy/