25/04/2026
If you’re hypertensive, don’t stop your medications just because you feel fine. Always consult your doctor.
EPISODE 2: I STOPPED MY BLOOD PRESSURE DRUGS BECAUSE I FELT FINE
Read to the end — this may save someone’s sight.
A 60-year-old retired civil servant, came to the eye clinic with sudden painless loss of vision in his right eye that started two days earlier. He said he woke up in the morning and noticed that the vision in that eye was “like looking through dirty water,” and within hours it became significantly worse.
There was no pain, no redness, and no trauma.
On further questioning, he admitted that he had been diagnosed with Hypertension about eight (8) years ago and had been placed on regular medications.
However, for the past yrs, he stopped taking his drugs on his own because he felt completely normal. He said he believed the condition had “gone away” since he no longer experienced headaches or dizziness.
He did not follow up in the hospital during this period.
BLOOD PRESSURE AT PRESENTATION;
- 198/112 mmHg.
VISUAL ACUITY;
- OD; HM (Hand movement very close to the face) He could not count fingers and there was no perception of light improvement beyond that.
- OS; 6/24.
PUPILLARY EXAMINATION;
- Showed a relative afferent pupillary defect in the right eye.
FUNDOSCOPY;
OD;
- Widespread flame-shaped hemorrhages scattered in all quadrants.
- The retinal veins were markedly dilated and tortuous.
- There were multiple cotton wool spots indicating areas of retinal ischemia.
- The optic disc appeared swollen and hyperemic.
- The overall appearance was classically described as a “blood and thunder” retina.
OS;
- There was generalized narrowing of the retinal arterioles.
- The arteriolar light reflex was increased, giving a silver-wiring appearance in some vessels.
- There were early arteriovenous crossing changes suggestive of chronic vascular compression from long-standing hypertension.
DX; A diagnosis of Central Retinal Vein Occlusion in the right eye secondary to uncontrolled Hypertension was made, with bilateral Hypertensive Retinopathy.
He was immediately referred for systemic stabilization and started on urgent blood pressure control. Ophthalmology care focused on monitoring for macular edema and neovascular complications, but the prognosis for the affected eye was guarded due to the extent of retinal damage already present.
When the situation was explained to him, he became emotional and repeatedly asked if the vision could come back. He kept saying, “But I felt fine… I had no symptoms.”
The explanation was simple but difficult — hypertension does not depend on symptoms. It damages silently over time, and by the time vision is affected, the injury is often already advanced.
This case highlights a very common but dangerous pattern: patients stopping antihypertensive medication because they feel well, only to present later with irreversible end-organ damage such as retinal vascular occlusion.
The eye findings in this patient were not just an eye problem — they were a reflection of systemic vascular damage from uncontrolled hypertension.
Eyeball world
