Hypertensive retinopathy

A grade 3 hypertensive retinopathy

A grade 4 hypertensive retinopathy showing
disc oedema and hard exudate at the macula

Nowadays it is uncommon to encounter malignant hypertension due to good screening programme and effective 
treatment for high blood pressure. However, you must be able to recognize the features of hypertensive retinopathy 
especially that of malignant hypertension. Early hypertensive retinopathy (grade 1 and 2) are commonly seen in the 
presence of other retinal conditions such as branch retinal vein occlusion, branch retinal artery occlusion or 

In the examination, if the main focus is on hypertensive retinopathy the patient usually has grade 3 or 4 hypertensive 
retinopathy. In grade 3: there are retinal arterioles narrowing with artero-venous nipping. The retina contains 
flame-shaped and blot haemorrhages, cotton-wool spots and hard exudates in the macula which may be star-shaped.

In grade 4: features of  grade 3 plus papilloedema.


1. How can hypertension affect the eye?

2. What are the retinal features of hypertension?

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