Elschnig’s spots were observed in 3 patients with severe hypertension. Extensive choroidal depigmentation as well as hyper-pigmentation surrounded by depigmentation were scattered over the whole retina. At the periphery, Siegrist’s bead string pigmentation was present (first patient). Despite the massive chorioretinal changes, only slight functional changes were evident. The retinal hypertensive changes predominated over choroidal vascular lesions (second patient). Elschnig’s spots were present almost only unilaterally (third patient). Choroidal vascular changes predominated in the presence of acute hypertension (first and third patient), whereas retinal vascular changes were the result of a more gradual onset of hypertension (second patient).