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? Arteriolosclerosis. This occurs over many years, and is thought to result mainly from leakage of plasma across the vascular endothelium. The arteriolar walls are homogeneously thickened with hyaline material, and are less able to respond to fluctuations in blood pressure.
? Arteriolar leakage and occlusion. The physiological reflex response to an acute elevation in blood pressure is vasoconstriction. However, with severe or sustained hypertension, blood components leak into the vessel wall. This results in vascular damage and disruption of the blood-retinal barrier. Histologically, there is fibrinoid necrosis with inflammatory cell infiltrates.
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