Make a handrawn easily reproducible diagram of hypertensive retinopathy for my opthalmology theory exam
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Here's your exam-ready diagram. Here's a quick rundown of what's shown, graded by the Keith-Wagener-Barker (KWB) classification:
Keith-Wagener-Barker Grading
| Grade | Features |
|---|---|
| 1 | Generalized arteriolar narrowing (A:V ratio < 2:3) |
| 2 | AV nicking/nipping at crossings + copper wiring (sclerotic arterioles) → silver wiring (severe sclerosis) |
| 3 | Flame-shaped hemorrhages, cotton-wool spots (nerve fiber layer infarcts), hard exudates in macular star pattern |
| 4 | All of Grade 3 + papilledema = "malignant hypertension" |
Key features to remember for the exam:
- AV nicking — arteriole compresses the vein at crossing points (shared adventitial sheath)
- Flame-shaped hemorrhages — follow the nerve fiber layer; distinguish from dot-blot hemorrhages of diabetic retinopathy
- Macular star — hard lipid exudates radiating from fovea (due to leaky vessels + Henle's fiber layer anatomy)
- Cotton-wool spots — microinfarcts of the nerve fiber layer, appear fluffy/white
- Copper/silver wiring — progressive arteriolar sclerosis reflecting chronic HTN
- Elschnig spots — focal chorioretinal atrophy from previous choroidal infarcts (sign of prior acute HTN episodes)
The inset boxes at the bottom show close-up anatomy of AV nicking, copper wiring, macular star, and a cotton-wool spot — all high-yield for a theory paper.
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