What is hypertensive retinopathy?

Hypertensive retinopathy is a condition that affects the retina, the light-sensitive tissue at the back of the eye, due to high blood pressure, or hypertension. It occurs when the small blood vessels in the retina become damaged as a result of persistently elevated blood pressure.

Hypertensive retinopathy is classified into various stages depending on the severity of the retinal changes observed during an eye examination. Here are the main stages of hypertensive retinopathy:

1. Grade 1 (Mild):

- Narrowing or constriction of small retinal blood vessels, known as retinal arteriolar narrowing.

- Slight changes in the appearance of the optic disc (the part of the retina where the optic nerve enters the eye).

2. Grade 2 (Moderate):

- More pronounced arteriolar narrowing.

- Changes in the optic disc become more evident.

- Possible presence of cotton wool spots (small, fluffy white areas in the retina) and microaneurysms (tiny, saccular dilations of small blood vessels).

3. Grade 3 (Severe):

- Significant arteriolar narrowing.

- Optic disc swelling or edema.

- More numerous cotton wool spots and microaneurysms.

- Retinal hemorrhages (bleeding in the retina).

- Hard exudates (yellowish deposits of fatty material).

4. Grade 4 (Malignant):

- Severe arteriolar narrowing, with some vessels appearing almost thread-like.

- Extensive optic disc swelling.

- Numerous cotton wool spots, microaneurysms, retinal hemorrhages, and hard exudates.

- Macular edema (swelling of the central part of the retina responsible for sharp vision).

The severity of hypertensive retinopathy often correlates with the extent of blood pressure elevation and the duration of hypertension. As the condition progresses, it can lead to vision problems and, in severe cases, may be a sign of severe, uncontrolled hypertension requiring prompt medical attention.

Regular eye examinations, particularly for individuals with a history of hypertension, are crucial to detect and monitor any signs of hypertensive retinopathy. This allows early intervention and management of hypertension to prevent more serious complications and preserve vision.