The table below shows the Keith-Wagener classification of hypertensive retinopathy
| Stage | Features |
|---|---|
| I | Arteriolar narrowing and tortuosity |
| Increased light reflex - silver wiring | |
| II | Arteriovenous nipping |
| III | Cotton-wool exudates |
| Flame and blot haemorrhages | |
| • These may collect around the fovea resulting in a 'macular star' | |
| IV | Papilloedema |
Hypertensive retinopathy stage 4 - cotton-wool spots, retinal haemorrhages, a 'macular star' composed of intraretinal lipid exudates. The optic nerve head is swollen, the feature that separates grade 3 and grade 4 hypertensive retinopathy