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Cotton wool spots on the retina are caused by blocked blood flow and are often a sign of diabetes or high blood pressure. They do not usually affect vision but indicate a need for aggressive treatment of underlying conditions.
Cotton wool spots are yellow or white flocculent artifacts that arise on the surface of the retina, or the part of the eye that can detect, process, and sum light information for the brain. Retinal spots form after blood flow to the retina is blocked. These entities typically do not damage vision and are often reabsorbed naturally by the eye. There are many diseases and infections that can lead to the production of these spots, but the most common causes of this condition are diabetes and high blood pressure. The presence of these spots is an indication of advanced progression of these diseases and is a sign that these diseases need to be treated more aggressively to control their impact.
The retina is made up of layers of cells that collect information about light and transfer it to the brain through ganglion cells. Cotton wool spots are composed of cytoplasmic material that has leaked from ganglion cells onto the surface of the retina. This material is believed to leak out of the ganglion cells after an illness or infection blocks the delicate blood flow to the retina. When cytoplasmic material oozes from the damaged ganglion cells, it takes on the soft, fluffy appearance of the cotton or wool that gave this condition its name.
Typically, cotton wool spots do not reduce vision and do not require direct treatment. In fact, most patients don’t even know they have these objects in their eyes until a fundoscopy exam is done to evaluate eye health. These retinal artifacts, however, are a sign of disease or infection that has severely impaired blood flow to the retina. If the disease or infection that has damaged the blood supply to the retina and caused these spots is not identified and treated, more serious eye problems could develop.
The most common causes of these retinal artifacts are the diseases diabetes and high blood pressure, or hypertension. When eight or more cotton wool spots are observed in one eye, the potential impact of diabetes or high blood pressure is considered serious and immediate action is needed to control these medical problems. If diseases are not managed better, they will have a detrimental physiological impact on the retina. The existence of cotton wool spots in a patient infected with human immunodeficiency virus is an indication that the severity of the infection is substantial. Other medical conditions and infections that can produce these cotton-like artifacts include severe anemia, connective tissue disease, and leptospirosis.
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