- Abstract. Cotton-wool spots (CWSs) are common retinal manifestations of many diseases including diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome.
- Introduction. ...
- Case report. ...
- Discussion. ...
- Conclusion. ...
- Footnotes. ...
- References. ...
What are the causes of cotton wool spots?
These diseases can be generally divided by cause into ischemic, embolic, infectious, toxic, radiation-induced, neoplastic, tractional, traumatic, immune-mediated and idiopathic causes. Ischemic disorders that can result in cotton-wool spots include retinal vascular occlusions, ocular ischemic syndrome and severe anemia.
What is cotton wool disease?
The cotton wool disease is a bacterium that is often mistaken as fungi disease due to its symptoms. It is caused by Flavobacterium columnare, and it primarily affects the gills and skin of infected fish.
How common are cotton wool spots in AIDS?
Cotton Wool Spots. Cotton-wool spots are the most common ocular lesion seen in AIDS, occurring in 25–50% of patients6,67 and in up to 75% of cases by autopsy examination.57. From: Retina (Fifth Edition), 2013.
What are cotton wool spots in the eye?
Cotton-wool spots. Cotton-wool spots are often referred to using the misnomer “soft exudates” and are described as slightly elevated, small, yellow-white or gray-white, cloud-like, linear or serpentine lesions with fimbriated borders in the superficial retina (Fig. 51.13).
What causes cotton wool spots?
In theory, almost any abnormality that can cause an obstruction of the central retinal artery or a branch retinal artery (see “ Central retinal artery obstruction ”, p. 1323) could also cause a cotton-wool spot. A list of many of the abnormalities that have been associated with cotton-wool spots is shown in Box 69-2.
How many CD4 cells are in cotton wool spots?
In a cross-sectional study, the median CD4 count (per microliter [µl]) in patients with cotton-wool spots was 14 cells (range 0–160) and was 8 cells (range 0–42) in patients with CMV retinitis. 74 In the absence of other systemic vascular disease, such as hypertension or diabetes mellitus, AIDS must be considered in the differential diagnosis of cotton-wool spots owing to their very high prevalence in these patients. Whether these lesions are an early manifestation of AIDS remains to be elucidated, but they may be apparent in HIV-infected persons before the onset of opportunistic infections. 48
What is the name of the disease that Bergmeister first described?
Classic Lupus Retinopathy . Bergmeister first described retinal involvement in SLE in 1929. He noted cotton-wool spots and other lesions arising several weeks after a flare-up of the patient's cutaneous manifestations. The retinopathy is usually bilateral, but may be asymmetric.
How long does it take for cotton wool to heal?
Cotton-wool spots usually do not cause visual loss, but many patients relate a history of seeing “spots” in their visual field. Most resolve within 5-7 weeks, 142 although in diabetics they can remain for longer periods of time. 143
Can cotton wool spots be ocular?
Fortunately, most patients who present with cotton-wool spots have other systemic or ocular findings that help narrow down their specific etiology.
What causes cotton wool spots?
Diabetes mellitus and systemic hypertension are by far the most common cause of cotton-wool spots. In patients who have a cotton-wool spot and no known history of diabetes, an elevated blood sugar level is identified in 20 percent of patients and an elevated blood pressure (diastolic blood pressure of 90 mmHg or greater) in 50 percent of patients.
What is cotton wool?
A truly isolated cotton-wool spot in an otherwise healthy patient requires further investigation before ascribing it to idiopathic causes. First, the patient should be seen by his or her primary-care doctor for a complete history and physical examination, keeping in mind the differential diagnosis list described above. The primary-care physician should be aware of the possible etiologies associated with cotton-wool spots seen in Table 1. Again, the most common diagnosis, systemic hypertension and diabetes mellitus, warrants special attention.
Can white cell emboli cause cotton wool?
In addition, white cell emboli from long bone fractures or pancreatitis following thoracic and/or abdominal trauma can occlude precapillary arterioles, resulting in dramatic cotton-wool spots and hemorrhages seen in Purtcher's retinopathy.
What causes a retinopathy spot?
Diabetes and hypertension are the two most common diseases that cause these spots, and the best treatment would be to treat the underlying disease. In diabetes they are one of the hallmarks of pre-proliferative retinopathy. More rarely, HIV and Purtscher's retinopathy can also lead to the appearance of cotton wool spots.
What are the white spots on the retina?
Cotton wool spots are an abnormal finding on funduscopic exam of the retina of the eye. They appear as fluffy white patches on the retina. They are caused by damage to nerve fibers and are a result of accumulations ...
Why are nerve fibers damaged?
There is reduced axonal transport (and hence backlog and accumulation of intracellular products) within the nerves because of the ischemia. This then causes the nerve fibers to be damaged by swelling in the surface layer of the retina.
Do cotton wool spots represent the retina?
A 1981 analysis concluded that "in most instances, cotton-wool spots do not represent the whole area of ischaemic inner retina but merely reflect the obstruction of axoplasmic flow in axons crossing into much larger ischaemic areas".
What are Cotton Wool Spots?
Cotton wool spots can be defined as the abnormal findings that are identified on the regular examination of the retina (fundoscopic examination). The name is given due to the fact that these actually resemble cotton wool, being white patches present in different parts of the retina. It is believed that these appear in patients who have suffered nerve fiber damage, the cytoplasm commonly contained in the axon of the neurons having accumulated within the different layers of the nerve fiber.Because of the above-mentioned changes, the affected nerves suffer from an ischemic process and the axonal transport is actually reduced. The damage occurring at the level of the nerve fibers is believed to be caused by an inflammatory process within the eye retina. It is important to understand that the cotton wool spots are not actually locations where the ischemia has occurred at the level of the retina. Instead, they show areas where obstruction has appeared, as a result of axoplasmic material accumulating.According to the specialists in the field, cotton wool spots are accompanied by other pathological changes, such as infarcts occurring in the small blood vessels of the eye and intra-retinal bleeding. It is also worth mentioning that the cotton wool spots might become less visible with the passing of time.
How long does it take for cotton wool spots to go away?
Once the underlying condition is successfully treated or kept under control, the cotton wool spots are going to disappear on their own. In general, it can take between six and twelve weeks for these spots to go away, while this period might be prolonged in patients who have been diagnosed with diabetic retinopathy.
Is cotton wool asymptomatic?
In regard to the clinical manifestations, it is important to understand that, other from the identification on the retina, cotton wool spots are often asymptomatic. In the situation that they have expanded so as to involve the fovea, it is possible that the patient suffers from vision loss (impaired vision). Also, if the patient suffers from an underlying condition, such as diabetes or hypertension, he/she will present the characteristic symptoms for the condition in question (systemic symptoms).
Overview
- Disease
In otherwise healthy patients, the observance of a cotton wool spot (CWS) is not considered normal. A single cotton wool spot in one eye can be the earliest ophthalmoscopic finding in diabetic or hypertensive retinopathy. In a series of patients who had cotton-wool spots and no k… - Etiology
Can be categorized into: 1. Ischemic : hypertension, diabetes, ocular ischemic syndrome(CWS is less common), retinal vein occlusion, anemia, hyperviscosity state, hypercoagulable state, radiation, acute blood loss. 2. Immune and inflammatory conditions: systemic lupus erythemato…
Causes
Signs and symptoms
Pathophysiology
Diagnosis
Referred to as a form of retinal myopathies, cotton wools spots are commonly found to be a secondary manifestation to diseases like diabetes, hypertension, and AIDs. Cotton wool spots have become one of the hallmarks of pre-proliferative diabetic retinopathy, a condition caused by damaged blood vessels in the retina due to high blood sugar. Abundant cotton wool spots are also fou…
Treatment and Management
Cotton wool spots present as opaque fluffy white spots, sometimes with feather-like edges, on the retina when seen on a funduscopic exam. These opaque white areas are typically asymptomatic, but may cause some vision loss due to the underlying disease state. Cotton wool spots are a retinal condition that when present, frequently act as a significant indicator, or sign, of a variety of underlying disease states. These fluffy white spots are often accompanied by additi…
See also
Cotton wool spots are commonly caused by changes to the retina secondary to diabetes, hypertension, or blockages to blood vessels to the retina, such as central retinal vein occlusion. While at one point believed to have been the result of nerve damage in the retina, interruptions to axoplasmic flow to these nerves may result from organelle accumulation in the axons. This is further purported by the presence of cytoid bodies in ganglion axon cells, where the accumulatio…