Cotton Wool
𝘚𝘰𝘧𝘵 𝘌𝘹𝘶𝘥𝘢𝘵𝘦𝘴/ 𝘊𝘰𝘵𝘵𝘰𝘯 𝘞𝘰𝘰𝘭 𝘚𝘱𝘰𝘵𝘴
Nerve fibre layer infarcts
Occur secondary to local ischemia from pre-capillary retinal arteriole obstruction → obstruction of axoplasmic flow in the nerve fibre layer → swelling of nerve fibres → white fluffy appearance → cotton wool spots
𝐂𝐚𝐮𝐬𝐞𝐬:
Vascular Diseases : Diabetic Retinopathy, Hypertensive Retinopathy, Vein occlusions, Ocular Ischemic Syndrome, Papilledema, Radiation Retinopathy
Hematological Disorders: Anemia, Leukemia, Sickle Cells Anemia
Infectious Diseases: HIV Retinopathy, Neuroretinitis
Collagen vascular disorders: Giant Cell Arteritis, Behcet’s, SLE etc
𝐀𝐩𝐩𝐞𝐚𝐫𝐚𝐧𝐜𝐞:
Small, yellow white/ grayish white elevated lesions with a feathery border with striations parallel to the nerve fibres in the superficial retina
Obscures the underlying blood vessel
Commonly in posterior pole
Can resolve in weeks to months leaving a small depression known as ‘Depression Sign’
Other findings such as microaneurysms, retinal hemorrhages, hard exudates etc to be noted
𝐇𝐢𝐬𝐭𝐨𝐥𝐨𝐠𝐲:
‘Cytoid Bodies’ - Looks like cells but are eosinophilic segments of ganglion cell axons that are swollen because of defective axoplasmic flow
Packed with accumulations of mitochondria and other intracellular material
𝐅𝐅𝐀: Hypofluorescence due to capillary non-perfusion in area corresponding to the cotton wool spot as well as blockage by axoplasm stasis
𝐎𝐂𝐓: Hyper-reflective lesion in inner retinal layers
𝐰𝐰𝐰.𝐨𝐩𝐡𝐭𝐡𝐚𝐥𝐦𝐨𝐛𝐲𝐭𝐞𝐬.𝐜𝐨𝐦
Image from Rajan Eye Care Hospital
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