Retinal opacifications in patients may indicate underlying disease

WAIKOLOA, Hawaii — Detection of a cotton-wool spot in a non-diabetic patient requires a full examination in order to find the underlying cause, a surgeon said.

Gary C. Brown

"We used to just ignore this" because the spots would often disappear over the course of 5 to 7 weeks, Gary C. Brown, MD, MBA, said during Retina 2008, held here. Twenty years ago, in an effort to determine the cause, he analyzed non-diabetic patients with cotton-wool spots.

"Lo and behold, 96% had associated systemic disease, and bad diseases," he said. "So, if you see even one cotton-wool spot in a non-diabetic, you need an explanation ... right there in the chair."

Hypertension was seen in 20% of those studied, while 20% had undiagnosed diabetes, Dr. Brown said. The rest included a variety of diseases such as AIDS, radiation retinopathy, pancreatitis and others, he explained.

Areas of superficial retinal opacification are often secondary to the obstruction of terminal retinal arterioles that occur when autoregulation ability is exceeded, causing fibrinoid necrosis, he said. They are seen when diastolic blood pressure is between 105 mm Hg and 110 mm Hg, Dr. Brown said.

"One cotton wool-spot needs a complete work up, same as a stroke patient. You can't ignore it. If you don't want to do it, send them to the internist and tell them what to do," he said. "Nowadays, they need a stress test and there's a good chance you may save their life."