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An ophthalmoscopic view of the retina showing advanced signs of diabetic retinopathy including two pale cotton wool spots. Cotton wool spots are opaque fluffy white patches on the retina of the eye that are considered an abnormal finding during a funduscopic exam (also called an ophthalmoscopic exam). [1] Cotton wool spots are typically a sign ...
Advanced retinopathy lesions, such as microaneurysms, blot hemorrhages and/or flame hemorrhages, ischemic changes (e.g. "cotton wool spots"), hard exudates and in severe cases swelling of the optic disc (optic disc edema), a ring of exudates around the retina called a "macular star" and visual acuity loss, typically due to macular involvement.
Then larger abnormalities in retinal vessels: cotton wool spots, hemorrhages, lipid deposits called "hard exudates", intraretinal microvascular abnormalities, and abnormal-looking retinal veins. [5] Eventually, many progress to a stage where new blood vessels grow throughout the retina. These new blood vessels often break and bleed.
True papilledema may present with exudates or cotton-wool spots, unlike ODD. The optic disc margins are characteristically irregular in ODD but not blurred as there is no swelling of the retinal nerve fibers. Spontaneous venous pulsations are present in about 80 percent of patients with ODD, but absent in cases of true disc edema. [6]
Medical signs that can be detected from observation of eye fundus (generally by funduscopy) include hemorrhages, exudates, cotton wool spots, blood vessel abnormalities (tortuosity, pulsation and new vessels) and pigmentation. [3] Arteriolar constriction, seen as "silver wiring", and vascular tortuosities are seen in hypertensive retinopathy.
Patients with branch retinal vein occlusion usually have a sudden onset of blurred vision or a central visual field defect. The eye examination findings of acute branch retinal vein occlusion include superficial hemorrhages, retinal edema, and often cotton-wool spots in a sector of retina drained by the affected vein.
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Similar to hypertensive retinopathy, evidence of nerve fiber infarcts due to ischemia (cotton-wool spots) can be seen on physical exam. Symptoms may include headache, nausea, or vomiting. Chest pain may occur due to increased workload on the heart resulting in inadequate delivery of oxygen to meet the heart muscle's metabolic needs.