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Clinical Summary

Fundus changes that may be seen with hypertension include generalized and focal narrowing of arterioles, generalized arteriolar sclerosis (resembling copper or silver wiring), arteriovenous crossing changes, hemorrhages (usually flame-shaped), retinal edema and exudation, cotton wool spots, microaneurysms, and disk edema.

Diabetic retinopathy, many hematologic and vascular diseases, traumas, localized ocular pathology, and papilledema should all be considered.

Management and Disposition

The patient’s hypertension should be appropriately treated, and a search for other end-organ damage should be considered. The patient should be referred for appropriate long-term blood pressure management.


  1. Hypertensive arteriolar findings may be reversible if organic changes have not occurred in the vessel walls.

  2. Always consider hypertensive retinopathy in the differential diagnosis of papilledema.


Severe Hypertensive Retinopathy. Marked papilledema, diffuse flame hemorrhages, and cotton wool spots with hard exudates in a patient with severe hypertensive disease. (Photo contributor: Jeffrey Goshe, MD.)

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