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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