What’s the difference between cotton wool spots and exudates?

Cotton-wool spots are often referred to using the misnomer “soft exudates” and are described as slightly elevated, small, yellow-white or gray-white, cloud-like, linear or serpentine lesions with fimbriated borders in the superficial retina (Fig. 51.13).

What are cotton wool spots?

Cotton-wool spots (CWSs) are common retinal manifestations of many diseases including diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome. Clinically they appear as whitish, fluffy patches on the retina and eventually fade with time.

How can you tell the difference between drusen and hard exudates?

Exudates are differentiated from drusen which hyperfluoresce during the transit phase and become less prominent in late phases. Microaneurysms that appear as white dots with no blood visible in the lumen are considered hard exudates.

What are cotton wool spots retina?

Cotton-wool spots (CWS) (Figure) are acute signs of vascular insufficiency to an area of retina. They have been described in many conditions, but only occasionally cause symptoms in patients. The most common symptoms associated with retinal CWS can include scotoma, arcuate defects, blurred vision, and amaurosis fugax.

Do cotton wool spots obscure vessels?

Cotton wool spots appear on fundoscopy as white, fluffy lesions with hazy or feathered edges in the superficial retina. Underlying retinal vessels may be obscured.

What is hard exudates in diabetic retinopathy?

Hard exudates (HEs) in the retina are one of the hallmark signs of diabetic retinopathy (DR) and, when present within the macular region, indicate the presence or previous existence of diabetic maculopathy.

What are hard and soft exudates?

Soft exudates, or CWS, usually have a somewhat fluffy border that is perpendicular to the course of the nerve fibers in the nerve fiber layer, and a fairly abrupt edge that is parallel to the nerve fibers. Also, CWS are more whitish. Hard exudate, or lipid, is yellowish and granular in appearance.

What are exudates in the eye?

The fluid is made of cells, proteins, and solid materials. Exudate may ooze from cuts or from areas of infection or inflammation. It is also called pus. In people who have an eye disease called diabetic retinopathy, exudates form in the retina of the eye.

What layer of the retina are exudates?

outer plexiform layer Retinal hard exudates are seen often in eyes with diabetic retinopathy. The hard exudates are composed of lipid and proteinaceous material, such as fibrinogen and albumin that leak from the impaired blood–retinal barrier. They are deposited primarily in the outer plexiform layer of the retina.

Are drusen cotton wool spots?

On CF images, drusen have a similar bright appearance as exudates and cotton wool spots. Whereas cotton wool spots can be more easily identified by their generally larger size and different color appearance, exudates and drusen have very similar characteristics and differentiation is difficult.

What are hard exudates?

Hard exudates are composed of lipid and proteinaceous material that settle in the outer retinal layers. These plaques often cause significant visual loss when deposited in the foveal region.

What is the difference between hard and soft drusen?

Hard drusen are small and round, have well-defined borders and are often spread out. They are common as people age. Soft drusen are larger, have indistinct borders and tend to cluster together. Although both types of drusen should be monitored, hard drusen don’t usually cause vision problems.

Do cotton wool spots cause headaches?

We have observed three cases of isolated cotton-wool spot (CWS) accompanied by a history of migraine, and would suggest a pathophysiological association between these two clinical entities. All three patients presented with a new visual disturbance associated with recent migraine.

Why does neovascularization occur?

Corneal neovascularization is a condition where new blood vessels invade into the cornea from the limbus. It is triggered when the balance between angiogenic and antiangiogenic factors are disrupted that otherwise maintain corneal transparency.

What are dot and blot hemorrhages?

Dot and blot hemorrhages occur as microaneurysms rupture in the deeper layers of the retina, such as the inner nuclear and outer plexiform layers. These appear similar to microaneurysms if they are small; fluorescein angiography may be needed to distinguish between the two.

Are cotton wool spots normal?

In otherwise healthy patients, the observance of a cotton wool spot (CWS) is not considered normal. A single cotton wool spot in one eye can be the earliest ophthalmoscopic finding in diabetic or hypertensive retinopathy.

Will cotton wool spots go away?

Cotton-wool spots are tiny white areas on the retina, the layer of light-sensing cells lining the back of the eye. Caused by a lack of blood flow to the small retinal blood vessels, they usually disappear without treatment and do not threaten vision.

Can lupus cause cotton wool spots?

Mild lupus retinopathy consists of cotton–wool spots, perivascular hard exudates, retinal hemorrhages, and vascular tortuosity [7]. Moderate lupus retinopathy has focal or generalized arteriolar constriction and venous tortuosity.

Do hard exudates resolve?

Subfoveal hard exudates usually respond poorly to focal laser treatment, but may slowly resolve leaving behind a retinal pigment epithelium (RPE) scar and subfoveal fibrosis with associated poor visual acuity.

Where are exudates in the retina?

Exudates are usually located in or adjacent to the outer plexiform layer because they are lipid residues that originate from damaged capillaries found in the inner retina whereas drusen are deposits located between the retinal pigment epithelium (RPE) and Bruch’s membrane because the RPE is not functioning correctly.

Where are dot blot hemes located?

Commonly known as “dot or blot,” these are found within the inner nuclear or outer plexiform layers of the retina. They fill the entirety of the retinal layers, occupying and displacing the normal retinal architecture, therefore forming round, uniform hemorrhages.

Is cotton a wool?

Cotton wool consists of silky fibers taken from cotton plants in their raw state. … It is also a refined product (absorbent cotton in U.S. usage) which has medical, cosmetic and many other practical uses.

What causes hard exudates?

Retinal edema and hard exudates are caused by the breakdown of the blood-retina barrier, allowing leakage of serum proteins, lipids, and protein from the vessels.

What are the types of exudates?

Types of Exudate

How do exudates form?

Exudate is produced from fluid that has leaked out of blood vessels and closely resembles blood plasma. Fluid leaks from capillaries into tissue at a rate that is determined by the permeability of the capillaries and the hydrostatic and osmotic pressures across the capillary walls.

Is exudate good or bad?

Exudate is fluid that is produced from a wound and can constitute both ‘good news’ and ‘bad news. ‘ It aids acute wound healing, but can delay healing in chronic wounds. (‘good news’).

What can OCT diagnose?

OCT is useful in diagnosing many eye conditions, including:

What does drusen look like on Oct?

Drusen is the earliest AMD sign that is detected clinically in fundus examinations. On OCT, drusen appear as RPE deformation or thickening that may form irregularities and undulations (Figure 2).