Eye disease due to high blood pressure: symptoms, treatment and prevention

High blood pressure, or hypertension, is a common condition that affects millions of people worldwide. Its impact on the heart is well known, but its effects on the eyes are often overlooked. The eyes are particularly vulnerable: long-standing hypertension can lead to eye diseases and complications ranging from mild discomfort to severe vision loss.

Understanding the symptoms, treatment options and preventive measures is important for anyone managing high blood pressure.

Eye symptoms of high blood pressure

• Vision changes: high blood pressure can damage the blood vessels in the retina, the light-sensing layer at the back of the eye. You may notice blurred vision, difficulty focusing or, in some cases, sudden loss of vision.
• Double vision or headaches: increased pressure in the blood vessels that supply the eyes can cause double vision or headaches.
• Eye pain: some people with high blood pressure feel pain in the eyes, especially behind them.
• Floaters: high blood pressure can cause floaters, tiny specks or cobweb-like shapes that drift across your field of vision.
• Spots or lines in your vision: visual disturbances like these can be a sign of hypertensive retinopathy (see below).
• Loss of vision: in severe cases, hypertension can lead to vision loss or even blindness through conditions such as hypertensive retinopathy or retinal vein occlusion.

Eye diseases linked to high blood pressure

Hypertensive retinopathy

High blood pressure damages the blood vessels of the retina, causing bleeding, swelling and fluid build-up. Symptoms include vision changes, spots or lines in the field of vision and headaches; in severe cases it can cause blindness.

Retinal vein occlusion

High blood pressure can block the veins that carry blood away from the retina, causing loss or distortion of vision.

Hypertensive optic neuropathy

Raised blood pressure can damage the optic nerve, which carries signals from the eye to the brain. This can cause vision loss, particularly of side (peripheral) vision, and even blindness if it is not treated.

Choroidopathy

In some cases, high blood pressure affects the choroid, the layer of blood vessels beneath the retina. Fluid builds up under the retina, leading to distorted vision and vision loss.

Treatment

• Blood pressure control: the main treatment is controlling blood pressure to prevent further damage to the eyes. This usually involves lifestyle changes, such as a healthy diet and regular exercise, and medicines prescribed by your doctor.
• Medicines for the eye condition: depending on the condition and its severity, your eye doctor may prescribe eye drops or oral medicines to relieve symptoms and slow the damage, or medicines such as anti-VEGF drugs or corticosteroids to reduce inflammation and fluid build-up in the eye.
• Laser treatment: in severe retinopathy or vein occlusion, laser therapy may be used to seal leaking blood vessels or improve blood flow to the retina.
• Surgery: in advanced cases where other treatments have not worked, surgery may be needed to deal with damaged blood vessels or remove scar tissue. Read more about retina surgery.

Prevention

• Regular eye examinations: routine eye check-ups can pick up early signs of hypertensive eye disease before symptoms become severe, so it can be treated in time.
• Regular blood pressure checks: monitor your blood pressure regularly and follow your doctor's advice on managing it.
• A healthy lifestyle: eat a balanced diet rich in fruit, vegetables and whole grains, limit salt, exercise regularly, limit alcohol and avoid tobacco.
• Taking medicines as prescribed: if you have been prescribed blood pressure medicines, take them as directed and attend your follow-up appointments.
• Managing stress: long-term stress can raise blood pressure. Meditation, deep breathing, yoga, relaxation exercises or hobbies can help.

People with diabetes as well as high blood pressure should also read about regular retina screening for diabetes.

In short

High blood pressure can seriously affect eye health and lead to several eye diseases and vision problems. Recognising the symptoms, getting timely treatment, controlling blood pressure and having regular eye check-ups are the best ways to protect your sight. If you have hypertension, work closely with your doctor and your ophthalmologist (eye specialist) to look after both your blood pressure and your eyes.