Hypertensive Retinopathy

Key points

• Grade I: silver wiring/arteriolar narrowing.
• Grade II: AV nipping with focal arteriolar narrowing.
• Grade III: + flame haemorrhages and cotton-wool spots.
• Grade IV: + papilloedema (malignant hypertension) — emergency.
• Keith-Wagener-Barker classification; grades III–IV indicate target-organ damage.

Decision points in this pathway

• Grade IV (papilloedema)?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.