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Classification of hypertensive retinopathy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Modern practice classifies changes into two groups:

  • compensated hypertensive retinopathy - groups 1 and 2 in older sources:
    • arteriolar changes - mild, generalised attenuation; increased tortuosity; increased opacity with resultant heightened light reflex - "copper" or "silver" wiring
    • plus constriction of veins at the arteriovenous crossings - "AV nipping"

  • accelerated hypertensive retinopathy - groups 3 and 4 in older sources:
    • cotton wool spots (retinal infarcts due to pre - capillary closure), flame haemorrhages, and hard exudates - may surround the macula forming a partial or complete "star"
    • papilloedema and often, retinal oedema at the posterior pole of the eye. Visual impairment accompanies macula involvement.

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