Ophthalmologycommon
A 71-year-old man with long-standing poorly controlled hypertension wakes to find the vision in his left eye blurred. There is no pain, no flashing lights and no new floaters. Corrected acuity is 6/36 on the left and 6/6 on the right, and the left field is full to confrontation. The pupils react equally and neither dilates when the torch is swung. The red reflex is present and the fundus is easily seen: the veins are dilated and tortuous, blot haemorrhages are scattered across all four quadrants, there are several small fluffy white patches, and the disc margins are blurred. Which one of the following best explains this fundus appearance?