Hypertensive Retinopathy

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Classification (Modified Scheie)

  • Grade 0: No changes
  • Grade 1: Subtle arterial narrowing, beginning crossing signs
  • Grade 2: Obvious arterial narrowing, obvious crossing signs, Salus’s sign (deflection of retinal vein as it crosses the arteriole)
  • Grade 3: Grade 2 + retinal haemorrhages, exsudates, cotton wool spots, macular edema
  • Grade 4: Grade 3+ optic disc edema 1


  • measure blood pressure
  • cardiovascular risk factors
  • consider fluorescence angiography


  • treat blood pressure, emergency referral for very high blood pressure/severe hypertensive retinopathy


  • EyeWiki Hypertensive Retinopathy
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; John E Salmon MD; Elsevier; 9th Edition (2019)
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition(2021)
  • 1 von Eyerounds.org, © The University of Iowa; Licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
    • 1 Contributor: C. Blake Perry, MD, The University of Iowa