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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 of another disease state, most common of which is diabetic retinopathy. [2]
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.
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.
Image produced is two-dimensional, unlike 3D in indirect binocular ophthalmoscopy; Difficulty observing and assessing abnormalities (e.g. cotton wool spots) due to lack of depth appreciation on images; Less magnification and image clarity than indirect ophthalmoscopy; Conditions such as cataracts will reduce image clarity
Examination findings may include microaneurysms, cotton wool spots, dot and blot hemorrhages, and neovascularization. [8] [10] Dilated fundus exam is the preferred method of diagnosis, as undilated exam may be too limited to visualize lesions or neovascularization that are more peripheral. [11]
Findings that can be identified with fundoscopic examination include different types of retinal hemorrhages and vitreous hemorrhages, neovascularization, cotton wool spots, drusen, changes in the caliber or shape of the retinal blood vessels, chanegs in optic nerve color and shape, changes in the retinal pigmented epithelium (RPE), uveal nevus ...
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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]