Hypertensive Retinopathy—Moderate (Vessel Changes and Cotton-Wool Spots)

Moderate hypertensive retinopathy is characterized by thinned, straight arteries; intraretinal hemorrhages; and yellow hard exudates (top). Cotton-wool spots (bottom) are an additional feature of moderate hypertensive retinopathy. They are caused by focal axonal swelling of the retinal nerve fiber layer as a result of small vessel occlusion.

Images courtesy of Prof. J. Wollensak via the Online Journal of Ophthalmology (www.onjoph.org).