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Fundus changes that may be seen with hypertension include generalized and focal narrowing of arterioles, generalized arteriolar sclerosis (resembling copper or silver wiring), arteriovenous crossing changes, hemorrhages (usually flame-shaped), retinal edema and exudation, cotton wool spots, microaneurysms, and disk edema.
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Diabetic retinopathy, many hematologic and vascular diseases, traumas, localized ocular pathology, and papilledema should all be considered.
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Management and Disposition
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The patient’s hypertension should be appropriately treated, and a search for other end-organ damage should be considered. The patient should be referred for appropriate long-term blood pressure management.
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Hypertensive arteriolar findings may be reversible if organic changes have not occurred in the vessel walls.
Always consider hypertensive retinopathy in the differential diagnosis of papilledema.
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