Cotton-Wool Spots (Inner Retinal Ischemic Spots)

Abstract

Cotton-wool spots in malignant arterial hypertension have been known since Liebreich [1] described them in 1859. Cotton-wool spots are common, acute, nonspecific retinal lesions. Many articles in the literature have reported that they are seen in retinopathies due to a whole host of conditions. There is a voluminous literature on the subject, mostly based on anecdotal case reports. Conditions include hypertensive retinopathy, diabetic retinopathy, retinal vein occlusion, transient retinal artery occlusion, carotid artery disease, cardiac valvular disease, Purtscher's retinopathy, interferon-associated retinopathy, giant cell arteritis, systemic lupus erythematosus, polyarteritis nodosa, Wegener's granulomatosis, dermatomyositis, Henoch-Schonlein purpura, IgA nephropathy, human immunodeficiency virus retinopathy, cytomegalovirus retinitis, Bartonella henselae neuroretinitis, ocular Lyme borreliosis, dengue fever, malaria retinopathy, leptospirosis, radiation retinopathy, bone marrow transplantation retinopathy, metastatic carcinoma, leukemic retinopathy, Hodgkin's disease, X-linked lymphoproliferative disorder, sarcoidosis, Takayasu's arteritis, retinopathy of pancreatitis, pernicious anemia, polycythemia vera, methotrexate-induced blood dyscrasia, nonfamilial amyloidosis, intravenous drug abuse, and, occasionally, following a marked fall of blood pressure [2]. Brown et al. [3] described the incidence of various diseases associated with cotton-wool spots in 24 patients.