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Hypertensive Retinopathy

ILLUSTRATION: This fundus exhibits all of the features of Grade 4 hypertensive retinopathy including:

  • Narrowing of the arterioles
  • Splinter (flame) hemorrhages: Are superficial and assume the contour of the nerve fiber layer.
  • Cotton wool spots: Focal areas of ischemic retina.
  • Hard exudates: Are lipid and protein residues of capillary leakage. In the macula they tend to radiate in star fashion.
  • Edema of the disc: The disc margins are blurred (papilledema) with adjacent splinter hemorrhages and cotton wool spots.

Hypertensive Retinopathy

DISCUSSION: There have been many classification models of hypertensive retinopathy. The following is a modified Scheie classification.1


  1. Barely detectable arteriole narrowing.
  2. Arteriol narrowing and focal irregularities.
  3. Grade 2 plus retinal hemorrhages and exudates.
  4. Grade 3 plus disc swelling

The more severe retinal findings are seen in conditions such as renal hypertension and toxemia of pregnancy and indicate an urgent need for treatment.

  1. AM Acad Ophtho Basic and Clinical Science Course. 2008-2009 12: Retina and Vitreous, pp 107-109.