It is said that the eyes are the windows to the soul, and by looking at the fundus, we can see the process, development, regression and prognosis of many diseases, such as hypertension. Hypertension is a common disease, many patients only know to take medication to control blood pressure, but have not thought that hypertension can also bring about eye lesions, such as secondary fundus arteriosclerosis, hemorrhage, macular disease, optic neuropathy, etc., the rate is even up to 70%. So, why does hypertension cause fundus pathology? When blood pressure rises sharply in the early stages of hypertension, the retinal arteries will undergo temporary functional constriction, i.e., arterial spasm, which is manifested as transient blurred vision, and when the blood pressure normalizes, the arterial diameter returns to normal and the vision becomes clear again. If the blood pressure does not drop and the spasm is not relieved for a long period of time, it will develop into atherosclerotic stenosis. Ophthalmologists examining the fundus will find enhanced arterial reflection, cross-compression of arteries and veins, and in severe cases the arteries show copper wire or silver wire-like changes, further development can be seen in vascular tortuosity, vascular white sheaths, and hypertensive retinopathy: retinal edema, hemorrhage, cotton wool spots, hard exudate, optic papillary edema, and hypertensive chorioretinopathy. In general hypertensive patients when the blood pressure is controlled at normal levels, the fundus can be restored to its original state. Retinal edema, hemorrhage, and cotton wool spots may subside within a few weeks, while hard exudates may take several months to subside. If blood pressure rises again, fundus lesions can still appear and keep getting worse. Therefore, fundus examination is not only an important basis for the diagnosis of ophthalmic disease, but also an important test to determine the extent of hypertension and to understand the prognosis. For patients with eye disease caused by hypertension, the treatment of eye disease should not be neglected, and we should not forget that controlling blood pressure is the root cause of the problem. Therefore, it is especially important for patients with eye disease to lower their blood pressure to reach the standard, and it is important for patients to monitor their blood pressure regularly and choose long-acting and stable drugs that can provide more protection.