High Blood Pressure and Its Effect on the Eyes

High Blood Pressure affects vessels throughout the body. The vessels in the eyes are particularly affected.

Increased blood pressure is often detected during the examination of the fundus, as the vessels of the retina respond and change relatively early to high blood pressure values.

Eye in Cross-Section - Consequences of High Blood Pressure

The diagnosis is then Fundus hypertonicus. Fundus hypertonicus refers to damage to the arterial vessels (arterioles) of the retina due to high blood pressure. The typical changes of a fundus hypertonicus present as narrowed thin vessels due to vasoconstriction - the constriction of vessels in response to excessively high blood pressure. In advanced stages, Gunn signs can be observed. These indicate a compression of the crossing veins at the junctions with the hardened, narrowed arterioles.

The fundus hypertonicus is classified into four stages, and from stage three onwards, it is also referred to as hypertensive retinopathy.
Depending on the stage, the vessels appear functionally altered, markedly altered, and in the further course as so-called copper wire arteries, and in the last stage as silver wire arteries. The designations arise from the different reflex phenomena that provide insight into the degree of change of the vessels.

Stage	Manifestation
I	mild, generalized narrowing of the arterioles, noticeable tortuosity, no focal stenoses
II	severe, generalized vascular narrowing with focal stenoses, positive Gunn sign
III	additional hemorrhages, hard exudates, cotton wool spots
IV	additional papilledema and optic atrophy

The vessels can also become occluded or become more convoluted and form small bulges. These damages to the vessels reduce the supply of nutrients to the nerve cells. Deposits and bleeding can occur in the retina. Ultimately, this can lead to the death of the nerve fibers of the retina. This can result in retinal detachment.
In the earlier stages, no symptoms are noticeable. With the progression of the disease, there is a reduction in visual acuity as well as visual field losses.

If there is severe damage, it can lead to swelling of the optic nerve due to venous congestion - a so-called papilledema. Visual disturbances up to blindness can be a consequence of high blood pressure.
If these pressure-related visual disturbances occur acutely (for example, in the context of a hypertensive crisis), they are often reversible. However, if the blood pressure is chronically high, the changes in the eyes can also become chronic, and vision may continue to decrease.

A tip for hypertensives who need new glasses:

Have your new glasses fitted only when your medication is well adjusted. Some blood pressure medications can (like other medications, for example, pain relievers) affect visual performance. This varies individually. There may also be increased fatigue during a medication change or adjustment, which can further reduce vision. Therefore, opticians recommend fitting the new visual aid only when the medication adjustment is stable.

Low Blood Pressure as a Risk Factor for Glaucoma (Green Star)

Too low blood pressure during the night can also affect the eye. The potential resulting under-supply of the eye has been identified as a risk factor for the development of glaucoma, also known as Green Star. This does not only affect people whose blood pressure is generally low but can also occur in patients with high blood pressure whose blood pressure values drop too low at night.

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By Sabine Croci. This article is medically reviewed. Last updated (01/2024).
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High Blood Pressure and Its Effect on the Eyes

Low Blood Pressure as a Risk Factor for Glaucoma (Green Star)

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