Usually, the early grades of hypertensive retinopathy go undetected. A patient may have no significant signs or symptoms to report nor any apparent reason to seek medical attention.
However, as his diastolic blood pressure remains elevated in grades III and IV, retinal lesions may produce blurred vision and scotomata (blind gaps in his visual field). Papilledema or hemorrhage in the macula can result in blindness.
Diagnostic Tests
A physician uses an ophthalmoscopic examination to diagnose hypertensive retinopathy. This examination is used to detect constricted retinal vessels in grades I and II retinopathy and to detect hemorrhages, yellow exudates, and papilledema in grades III and IV retinopathy.
If the patient has papilledema, the ophthalmoscopic examination will reveal engorged, tortuous retinal veins, flame-shaped retinal hemorrhages in the superficial nerve fiber layer, and round hemorrhages in the deeper nerve layers.