Posterior Segment
Hypertensive Retinopathy
Also known as: hypertensive retinopathy, hypertensive retinal changes, AV nicking, arteriolar narrowing, flame haemorrhages, cotton wool spots, malignant hypertension
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Hypertensive retinopathy reflects retinal vascular damage related to elevated blood pressure. Mild chronic signs support systemic risk communication; haemorrhages, cotton wool spots, macular involvement, or disc swelling require urgent medical assessment for severe or malignant hypertension.
Recognition
Symptoms: what patients report
- Often asymptomatic in mild chronic disease.
- Blurred vision, headache, or neurological symptoms may occur with severe hypertension.
- Symptoms may relate to macular involvement or optic disc swelling.
Signs: what the examination shows
- Arteriolar narrowing and arteriovenous crossing changes.
- Flame-shaped haemorrhages and cotton wool spots in more severe disease.
- Optic disc swelling may indicate malignant hypertension or another emergency cause.
- Elschnig spots (focal choroidal infarcts) and serous retinal detachment mark choroidal ischaemia in acute severe hypertension.
What OptoGuide™ covers for hypertensive retinopathy
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked New Zealand therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Hypertensive Retinopathy — EyeWiki
- Hypertensive Retinopathy. Wong TY, Mitchell P. The New England Journal of Medicine. 2004;351(22):2310-7.
- Hypertensive eye disease. Cheung CY, Biousse V, Keane PA, Schiffrin EL, Wong TY. Nature Reviews. Disease Primers. 2022;8(1):14.
- The Underutilized Ocular Fundus in Emergency Departments: Current Progress and Future Prospect of Imaging and Artificial Intelligence for Patient Care. Wang Y, Hu W, Zhang X, et al. Ophthalmology Science. 2026;6(10):1013
- Optometry Australia — A Diagnostic Guide to Posterior Eye Disease, Chairside Reference Pack (Centre for Eye Health), Version 2.0, 2026: Retinal Vascular Disease
- ESC Council on hypertension position document on the management of hypertensive emergencies. van den Born BJH, Lip GYH, Brguljan-Hitij J, et al. European Heart Journal - Cardiovascular Pharmacotherapy. 2019;5(1):37-46.
- A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline. Shanmugalingam R, Barrett HL, Beech A, et al. Medical Journal of Australia. 2024;220(11):582-591.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.