Cotton wool spots (73/1700)

Pt with puffiness of face and rash, showing cotton wool spots on fundoscopy. What’s the dx?

a. Macular degeneration
b. Hypertensive retinopathy
c. Diabetic background
d. Proliferative diabetic retinopathy
e. SLE


























answer: E

history points to sle: rash (malar rash), puffiness (lupus nephritis)

DD cotton wool spots
- Ischemic : hypertension, diabetes, ocular ischemic syndrome, retinal vein occlusion, anemia, hyperviscosity state, hypercoagulable state, radiation, acute blood loss.
- Immune and inflammatory conditions: systemic lupus erythematosus, dermatomyositis, scleroderma, polyarteritis nodosa, giant cell arteritis.
- Infectious: HIV retinopathy, cat-scratch disease, rocky mountain spotted fever, leptospirosis, onchocerciasis, bacteremia, fungemia.
- Embolic: carotid emboli, cardiac emboli, cardiac valvular disease, endocarditis, rheumatic heart disease, deep venous emboli, Purtscher-like retinopathy, foreign-body emboli.
- Neoplastic: lymphoma, leukemia, metastasis.
- Medication induced: interferon retinopathy.
- Miscellaneous: trauma