Cotton-Wool Spots and Retinal Hemorrhages

In the past few months, medical practice has changed faster than in the past few decades. This was due to the coronavirus disease (COVID-19) pandemic. Ophthalmic problems are most significant in patients with severe pneumonia. The exact incidence of conjunctivitis in COVID-19 patients ranges from 0.8 to 31.6 %. Optical coherence tomography demonstrated hyperreflective lesions at the level of ganglion cells and inner plexiform layers, more pronounced in the papillomacular bundle of both eyes. Retinal hemorrhages were found in at least one eye in five patients (9.25 %), cotton wool spots were detected in four people (7.4 %), and drusen was observed in six patients (11.1 %). On examination of the fundus, dilated veins were revealed in 15 patients (27.7 %), tortuous vessels — in 7 individuals (12.9 %). The literature reports describe patients who were diagnosed with COVID-19 after the detection of diplopia and ophthalmoparesis. The incidence of ocular complications in patients of the intensive care units in different studies ranges from 3 to 60 %. The most common manifestations are ocular surface diseases, increased intraocular pressure, and disorders of the anterior and posterior segments.

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A Case of Bilateral Retinal Hemorrhage with Cotton Wool Spot Following Viper Bite

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i3.18909 ◽

2015 ◽

Vol 14 (3) ◽

pp. 297-298

Author(s):

Subhasis Jana ◽

Saumen Kumar Chaudhuri ◽

Purban Ganguly ◽

Sumi Ghorai

Keyword(s):

Degradation Products ◽

Medical Science ◽

Retinal Hemorrhage ◽

Fundus Examination ◽

Cotton Wool ◽

Retinal Hemorrhages ◽

Cotton Wool Spots ◽

Fibrin Degradation Products ◽

History Of

A 38 years male, admitted in the department of Internal Medicine with a history of snake bite in his left lower leg during agriculture work. He was treated with anti snake venom after admission. He had history of dimness of vision in both eyes. On examination, swelling and subcutaneous hemorrhage was noted in his left leg. His best corrected visual acuity (BCVA) was 6/60 in the both eyes. Fundus examination with 90 D lens and Indirect Ophthalmoscopy of both eyes showed retinal hemorrhage with cotton wool spots. Blood tests revealed increased titers of D-dimer and fibrin degradation products. The patient was followed up regularly at 2 weeks interval and BCVA and Fundus examination was carried out. At the end of 10 weeks, retinal hemorrhages had significantly cleared in both eyes with improvement of vision in both eyes (BCVA of right eye at last follow-up 6/6 and left eye 6/9).Bangladesh Journal of Medical Science Vol.14(3) 2015 p.297-298

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Hemi Retinal Vein Occlusion a Particular Form of Retinal Vein Occlusion

Austin Journal of Clinical Ophthalmology ◽

10.26420/austinjclinopthalmol.2021.1117 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Khanaouchi N ◽

◽

Mouzarii Y ◽

Reda K ◽

Oubaaz A ◽

...

Keyword(s):

Medical History ◽

Retinal Vein Occlusion ◽

Fundus Examination ◽

Cotton Wool ◽

Slit Lamp ◽

Retinal Hemorrhages ◽

Sudden Loss ◽

Cotton Wool Spots ◽

Vein Occlusion ◽

History Of

We report a case of 55-year-old women, with a medical history of hypertension and diabetes, who complained of a sudden loss of vision of her left eye. Her VA was less than 20/200; slit lamp and gonioscopy were unremarkable. Dilated fundus examination had shown an Aspect of HRVO with a Thunder of flame shaped retinal hemorrhages covering the inferior half of the retina, tortuous veins and cotton-wool spots.

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Purtscher-Like Retinopathy

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/421329 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Rita Massa ◽

Carolina Vale ◽

Mafalda Macedo ◽

Maria João Furtado ◽

Miguel Gomes ◽

...

Keyword(s):

Acute Pancreatitis ◽

Anterior Segment ◽

Peripheral Retina ◽

Cotton Wool ◽

Fiber Layer ◽

Retinal Hemorrhages ◽

Nerve Fiber Layer Thickness ◽

Cotton Wool Spots ◽

The Right

Purtscher-like retinopathy is associated with retinal hemorrhages and ischaemia probably due to the complement-mediated leukoembolization. It is a rare and severe angiopathy found in conditions such as acute pancreatitis.Case. We present a case of a 53-year-old man who presented with a Purtscher-like retinopathy associated with the development of acute pancreatitis in the context of a Klatskin tumour (a hilar cholangiocarcinoma). The ophthalmologic evaluation revealed the best corrected visual acuity (BCVA) of 20/32 in the right eye (RE) and of 20/40 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema, and RPE hypo- and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the LE. 15 months after the initial presentation, without ophthalmological treatment, there was an improvement of BCVA to 20/20 in both eyes and optical coherence tomography (OCT) revealed areas of reduction of retinal nerve fiber layer thickness corresponding to the previous cotton-wool spots.Conclusion. Purtscher-like retinopathy should not be neglected in complex clinical contexts. Its unclear pathophysiology determines an uncertain treatment strategy, but a meticulous follow-up is compulsory in order to avoid its severe complications.

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Progressive Localized Retinal Nerve Fiber Layer Defect Following Cotton Wool Spots and a Dot Hemorrhage

Soonchunhyang Medical Science ◽

10.15746/sms.11.029 ◽

2011 ◽

Vol 17 (2) ◽

pp. 134-137

Author(s):

Saemi Park ◽

Seung Joo Ha

Keyword(s):

Nerve Fiber ◽

Retinal Nerve Fiber Layer ◽

Cotton Wool ◽

Fiber Layer ◽

Nerve Fiber Layer ◽

Cotton Wool Spots ◽

Layer Defect ◽

Nerve Fiber Layer Defect ◽

Retinal Nerve Fiber

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The Association Between Obstructive Sleep Apnea and Cotton-Wool Spots in Nonproliferative Diabetic Retinopathy

Journal of VitreoRetinal Diseases ◽

10.1177/2474126421989576 ◽

2021 ◽

pp. 247412642198957

Author(s):

Halward M.J. Blegen ◽

Grant A. Justin ◽

Bradley A. Bishop ◽

Anthony R. Cox ◽

James K. Aden ◽

...

Keyword(s):

Body Mass Index ◽

Obstructive Sleep Apnea ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Body Mass ◽

Smoking Status ◽

Cotton Wool ◽

Nonproliferative Diabetic Retinopathy ◽

Cotton Wool Spots ◽

Obstructive Sleep

Purpose: This work reports the association of obstructive sleep apnea (OSA) and cotton-wool spots (CWS) seen in patients with nonproliferative diabetic retinopathy (DR). Methods: A random sample of patients diagnosed with DR between January 1, 2015 and December 31, 2018, were selected from medical-billing codes. Dilated funduscopic examination findings and medical history were analyzed by reviewing medical records. Results: CWS were present in 12 of 118 patients without OSA, compared with 11 of 32 patients with OSA (10.2% vs 34.4%, respectively; P = .002). OSA was more common in men (68.8%, P = .03) and associated with a higher body mass index (30.0 ± 5.0 without OSA vs 33.6 ± 5.5 with OSA, P < .001). When comparing those with and without OSA, there was no association with age; glycated hemoglobin A1c; stage of DR; insulin dependence; presence of diabetic macular edema; smoking status; or a history of hypertension, hyperlipidemia, cardiovascular disease, or other breathing disorder. Conclusions: The presence of OSA is associated with CWS in patients with DR, as well as male sex and a higher body mass index. Further research is needed to determine the ophthalmologist’s role in the timely referral of patients with CWS for OSA evaluation.

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