Abstract: Objective To observe the fundus imaging features of malignant hypertensive retinopathy. Methods The fundus imaging features of all patients with malignant hypertension who were admitted to Affiliated Hospital of Shandong Second Medical University from January 2011 to October 2023 were analyzed retrospectively. Fourteen patients（28 eyes） with malignant hypertension were in the observation group and 14 patients（28 eyes） with common hypertension were in the control group. The clinical data of fundus photography, optical coherence tomography（OCT）, and fundus fluorescein angiography（FFA） were collected to analyze and summarize the fundus imaging features of malignant hypertensive retinopathy. Results The 14 patients（12 males and 2 females） in malignant hypertension group had an average age of（36.0±8.9） years, mean systolic blood pressure of（207.0±20.0） mmHg, and mean diastolic blood pressure of（136.6±12.1） mmHg. All 14 patients were first visited in ophthalmology with visual acuity loss as the main clinical symptom, and had no history of hypertension. The main manifestations of fundus photography were as follows: hemorrhage, cotton velvet spot, macular awn-like rigid exudation, and optic papilla edema. The main manifestations of OCT were subretinal fluid, intraretinal fluid, massive high reflex in the inner layer of the retina, and punctate high reflex in the pigment epithelium. The main manifestations of FFA were as follows: high fluorescence of the optic papilla, low fluorescence of hemorrhage, punctate high fluorescence of the retina, and round accumulation of high fluorescence. Conclusions The main fundus manifestations of malignant hypertensive retinopathy are retinal hemorrhage, exudation, cotton velvet spot, serous retinal edema, optic papilla edema, and the onset of both eyes. When encountering the above clinical features, we should be highly vigilant against malignant hypertension to avoid missed diagnosis and misdiagnosis.