Cotton-wool spots entities

Clinic

Cotton wool spots are an abnormal finding on funduscopic exam of the retina of the eye. They appear as fluffy white patches on the retina. They are caused by damage to nerve fibers and are a result of accumulations of axoplasmic material within the nerve fiber layer. There is reduced axonal transport (and hence backlog and accumulation of intracellular products) within the nerves because of the ischemia. This then causes the nerve fibers to be damaged by swelling in the surface layer of the retina. Diabetes and hypertension are the two most common diseases that cause these spots, and the best treatment would be to treat the underlying disease. In diabetes they are one of the hallmarks of pre-proliferative retinopathy. More rarely, HIV and Purtscher's retinopathy can also lead to the appearance of cotton wool spots.

Complications of diabetic retinopathy include two phases

1. The first non-proliferative phase with symptoms of blurred vision and non-parallel visual blurs of the eyes
2. The second phase: formation of new vessels, retinal bleeding and cotton wool appearance in fundoscopy

Miasms

• HTLV-1 is the only miasm of Cotton wool spots
• HTLV-1 has a good coverage on retinal vasculitis, which means that the retinopathy developed is vascular and follows pigmentary degeneration.