Hypertensive retinopathy
Hypertensive retinopathy is the term that is used to describe the eye changes that happen in people who have high blood pressure. Hypertension is the name of the condition when the blood pressure is higher than normal for a prolonged period of time. It has profound effects on various parts of the eye, and in particular on the retina (the part of the sensitive inner eye lining that is responsible for vision).
In this article:
Treatment for Hypertensive Retinopathy
The treatment of hypertensive retinopathy and choroidopathy is focused on reducing systemic blood pressure and, if indicated, managing the underlying medical condition. High blood pressure is the only cause of this eye condition.
The optometrist or ophthalmologist who assess the eye changes in a person with undiagnosed hypertension is in a position to make care recommendations to prevent other organ damage and reduce the patient’s morbidity and mortality.
The management of hypertensive retinopathy depends on the severity of the disease:
- Mild hypertensive retinopathy: The treatment consists of controlling of BP with regular monitoring.
- Moderate hypertensive retinopathy: Referral to a physician is essential to exclude other associated factors like diabetes mellitus and to check for any cardiovascular abnormalities. Routine care including BP control and monitoring is a must.
- Severe hypertensive retinopathy: Requires urgent treatment and referral as it has the strongest association with mortality. Other systems such as renal, cardiovascular, and brain should be monitored for signs of TOD.
Lifestyle Changes
It is important to know the measures that can prevent all health problems, including eye disease:
- Weight control. See a nutritionist and Endocrinologist who can help you with weight loss
- Exercise. Regular cardio exercise will help you to keep blood vessels in tone and prevent high blood pressure
- Stress management.
The stroke risk is significantly decreased in people who adhered to ≥3 healthy lifestyle factors (never smoking, normal weight, moderate/high level of exercise, vegetable consumption≥3 times per week, and light/moderate alcohol drinking) compared with those who adhered to <3 healthy lifestyle factors.
Medications
As the main reason for the hypertensive retinopathy is high blood pressure, patients are encouraged to take their medications regularly. When blood pressure is high it affects the tiny blood vessels inside the eye and causes damage. A primary care doctor will recommend the pills which will keep the BP numbers in the normal range. Sometimes it takes few month to find the best combination on medications and lifestyle adjustments to get hypertension under control.
There are no official recommendations for routine screening for hypertensive retinopathy in asymptomatic patients who carry a diagnosis of systemic hypertension. However, if a patient without a diagnosis of hypertension presents with signs of mild hypertensive retinopathy, we recommend referral to a general practitioner within one week.
For moderate hypertensive retinopathy, the patient should be evaluated by a general practitioner. Patients who present with severe hypertensive retinopathy or hypertensive choroidopathy should have their blood pressure measured immediately and should be referred to the nearest emergency room for urgent blood pressure management.
There are no official recommendations for screening women with pregnancy-induced hypertension. But it is recommended that pregnant women were found to have hypertensive retinopathy on the eye exam should be referred to their obstetrician for evaluation of pre-eclampsia.
Prognosis
Untreated high blood pressure leads to more changes of the blood vessels of the retina and progression of the disease. it is important to address the main problem to prevent worsening of the eye problems.