Hypertensive Retinopathy

Acute BP elevation usually causes reversible retinal vasoconstriction. Hypertensive crisis can also cause optic disc oedema — disc oedema with elevated BP defines hypertensive crisis. Prolonged severe hypertension causes exudative retinal changes: haemorrhages, hard exudates, cotton wool spots.

Chronic hypertension

Usually asymptomatic early; late disease may show blurred vision and visual field deficits.

Grade	Findings
1	Subtle generalised arteriolar narrowing
2	Focal arteriolar narrowing + venule compression at AV crossings (AV nipping)
3	Grade 2 findings + retinal haemorrhages, hard exudates, cotton wool spots

Malignant hypertension (Grade 4)

Grade 3 findings plus optic disc swelling, along with headaches, eye pain, reduced visual acuity and focal neurological deficits.

Management: antihypertensives + emergency hospital admission.