A 58-year-old woman with long-standing poorly controlled hypertension undergoes fundoscopy. Findings include generalised arteriolar narrowing, focal arteriolar constriction with arteriovenous nicking, multiple flame-shaped haemorrhages, and several cotton wool spots. The optic disc appears normal. Using the Keith-Wagener-Barker classification, her hypertensive retinopathy is graded as:

• A Grade 1
• B Grade 2
• C Grade 4
• D Grade 3 ✓

Explanation

The Keith-Wagener-Barker system grades retinopathy progressively: grade 1 shows mild generalised arteriolar narrowing, grade 2 adds focal constriction and arteriovenous nicking, grade 3 adds haemorrhages and cotton wool spots, and grade 4 is defined by optic disc oedema. Cotton wool spots represent axoplasmic debris from nerve fibre layer ischaemia. This patient's normal disc excludes grade 4, making grade 3 the correct classification despite her severe vascular changes.

Reference: Khurana's Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.