Although the effects of raised blood pressure on the appearance of the fundus of the eye were recognised in the nineteenth century, the nature of the detailed changes is still disputed. Certain characteristic features, such as the nipping of the veins at arteriovenous crossings, narrowing of the arterioles, haemorrhages, papilloedema and exudates, are beyond doubt. Some confusion can be avoided if it is realised that the effects of raised blood pressure are modified by other changes in the eye because of natural ageing. It is now accepted that the exact cause of the raised blood pressure does not by itself influence the fundus appearance. However, the appearance of the retinal vessels and associated changes serve as a good guide to the severity of the disease and urgency of treatment.

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