Signs of Hypertension in the Eye

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Did you know that high blood pressure can show up in the eye?

In acute, malignant cases, patients may experience eye pain, headaches, or reduced visual acuity^[2]. In chronic cases, there may not be any symptoms. However, the complications of arteriosclerotic hypertensive changes will cause patients to present with the typical symptoms of vascular occlusions or macroaneurysms.

Clinical diagnosis

The signs of malignant hypertension are well summarized by the Modified Scheie Classification of Hypertensive Retinopathy^[3]:

Grade 0: No changes
Grade 1: Barely detectable arterial narrowing
Grade 2: Obvious arterial narrowing with focal irregularities (Figure 1)
Grade 3: Grade 2 plus retinal hemorrhages, exudates, cotton wool spots, or retinal edema (Figure 3)
Grade 4: Grade 3 plus papilledema (Figure 4