Symptoms:

Most people with hypertensive retinopathy do not have symptoms until late in the disease.

Malignant hypertension may cause the following sudden symptoms, and should be considered a medical emergency:

• Double vision or dim vision
• Headaches
• Visual disturbances, and sometimes sudden vision loss

Signs and tests:

Using an instrument called an ophthalmoscope, your health care provider can see narrowing of blood vessels, and signs that fluid has leaked from blood vessels.

The degree of retina damage (retinopathy) is graded on a scale of 1 to 4:

• At grade 1, you may not have symptoms.
• In between grades 1 and 4, there are a number of changes in the blood vessels, areas where blood vessels have leaked, and other parts of the retina.
• Grade 4 hypertensive retinopathy includes swelling of the optic nerve and of the visual center of the retina (macula). This swelling can cause decreased vision.

Fluorescein angiography may be used to examine the blood vessels.