Fig. 3. The fundus changes in hypertension, in order of appearance, are generalized narrowing of the arterioles, focal constriction, hemorrhages, exudates, and finally, edema of the disc. They reflect the severity of the hypertension. A. Earliest sign of hypertension showing only generalized narrowing of the arterioles with no change in the vessel wall thickness or reflex. B. Grade II hypertension showing generalized narrowing plus focal constriction and grade I arteriolar sclerosis with widening of the reflex stripe. C. Grade III hypertension showing generalized narrowing, focal constriction, hemorrhages, and exudate, and grade I arteriolar sclerosis with widening of the light reflex. D. Grade IV hypertension showing generalized narrowing, focal constriction, hemorrhages, and exudates and edema of the disc with grade I arteriolar sclerosis. (Scheie HG, Ashley BJ, Yanoff M: Medical ophthalmology: Hypertension and arteriosclerosis. In Scheie HG [ed]: Medical Ophthalmology: Ophthalmologic Manifestations of Systemic Diseases. Medicolor Illustration and Editorial Service, 1966)