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 ⁣ #ophthalmology #ophthal #retina #diabeticretinopathy #hypertensiveretinopathy #cottonwoolspots #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency