Hypertensive Retinopathy Grading – Simplified

Hypertensive retinopathy has been classified by Keith, Wagener & Barker and Scheie (hypertensive and arteriosclerotic features). With this mnemonic, we will have a grading with combination of all these classifications.

hypertensive retinopathy
Hypertensive retinopathy changes – schematic

Mnemonic: SAFEs

I – Slight Systemic (generalized) narrowing of arterioles

II – AV deflection (at Angle) and focal narrowing of arteriorles

  • Angled deflection of vein at AV crossing: Salu’s sign

III – Flame hemorrhages, Flame color arterioles and Frank AV crossing changes

  • Frank AV crossing changes:
    • Bonnet sign: Banking of veins at AV crossing
    • Marcus-gunn sign: Tapering of veins at AV crossing
  • Flame color arterioles: Copper wiring
  • Flame shaped hemorrhages, Cotton wool exudates and hard exudates

Mnemonic for Eponymous AV crossing changes:

Salu’s sign: “S” like venous deflection at AV crossing
Bonnet sign: “B” for Banking of vein distal to AV crossing
Gunn sign:

IV – Edema and Exudates surrounding macula + silver wiring

  • Edema: Papilledema
  • Exudates surrounding macula: Macular star

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