Q. What do you see on this fundoscopic exam?
a. Retinal detachment
b. Hard exudates
d. AV nicking
e. Cotton spots
f. Macular edema
1. You better know this. There is not much you need to know for ophthalmology, but this is one you need to know
2. These are cotton wool spots. Look at it and remember for the rest of your life
Q. You are most likely going to see cotton wool spots in a patient with-
e. Horner syndrome
1. 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.
2. Patients with diabetes mellitus might also harbor other typical retinal findings such as macular edema, retinal exudate, flame or dot/blot hemorrhages, microaneurysms, venous beading or microvascular abnormalities or proliferations. Conversely, patients with systemic hypertension would be expected to demonstrate generalized arteriolar narrowing, arteriolar/venous nicking and, in extreme cases, optic-disk swelling.
3. In addition to systemic hypertension and diabetes mellitus, cotton-wool spots may be found in numerous other diseases. These diseases can be generally divided by cause into ischemic, embolic, infectious, toxic, radiation-induced, neoplastic, tractional, traumatic, immune-mediated and idiopathic causes.