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Cotton wool spots

Disease
Cotton wool spots are fluffy white lesions in the retinal nerve fibre layer that represent areas of focal ischaemia and oedema. The retina has a high metabolic rate, and is highly susceptible to any disease process that restricts its arterial oxygen supply

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Symptoms

Cotton wool spots are asymptomatic. Symptoms may exist relating to the underlying cause, or to any ocular complications of this underlying cause.

Signs

Cotton wool spots appear on fundoscopy as white, fluffy lesions with hazy or feathered edges in the superficial retina. Underlying retinal vessels may be obscured.

Significance

Cotton wool spots indicate significant retinal ischaemia or other disorder. The underling cause requires identification and management.

Differential diagnosis

See the table below.

See also

Choroidal neovascularisation, Diabetic retinopathy, Hypertensive retinopathy, Central retinal artery occlusion, Central retinal vein occlusion, Ocular ischaemic syndrome (Ophthalmic artery hypoperfusion, Carotid occlusive disease), Lymphoma, Systemic lupus erythematosis, Acquired immunodeficiency syndrome (AIDS) Retinopathy, Cytomegalovirus retinitis, Radiation retinopathy.

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