Search results (93 results)

Apr 18 2025 by DR Rohit Gupta

The **myelinated nerve fibers of the optic disc** (also known as **medullated nerve fibers**) are retinal nerve fibers that retain their myelin sheath as they pass through the optic nerve head. Normally, retinal nerve fibers are unmyelinated to allow for light transparency, but in some cases, myelination extends anteriorly into the retina, appearing as a striking white, feathery patch on the optic disc or peripapillary retina. ### **Key Features:** 1. **Appearance:** - Dense, white, striated patches with feathery edges. - Typically located at the superior or inferior pole of the optic disc. - May obscure retinal vessels underneath. 2. **Clinical Significance:** - Usually **benign** and asymptomatic. - **Congenital** (present at birth or early childhood). - Rarely associated with **visual field defects** (e.g., scotomas corresponding to the area of myelination). - Occasionally linked with **high myopia** or **amblyopia** if extensive. 3. **Pathophysiology:** - Failure of oligodendrocytes or Schwann cells to stop myelination at the lamina cribrosa. - Normally, myelination stops at the optic nerve head, but in this condition, it extends into the retina. 4. **Diagnosis:** - **Fundoscopy:** Classic white, feathery appearance. - **Optical Coherence Tomography (OCT):** Shows thickened retinal nerve fiber layer (RNFL). - **Visual Field Testing:** May detect defects if large. 5. **Differential Diagnosis:** - Optic disc edema - Cotton wool spots - Retinoblastoma (rarely, but must be ruled out in children) 6. **Management:** - No treatment required if asymptomatic. - Monitor for amblyopia in children. - Rare cases with significant visual impairment may need further evaluation. ### **Fun Fact:** Myelinated nerve fibers are seen in **~0.5-1%** of the population and are usually an incidental finding.

Photographer: Dr Rohit gupta

Imaging device: Samsung S21

Condition/keywords: Medulated Nerve fibre, Medullated Nerve fibres, myelinated nerve fibers, Myelinated Nerve Fibres, optic disc drusen

Dec 5 2024 by Tejaswita Verma

Fundus image of a middle aged male with NVD, multiple dot blot and flame shaped hemorrhages, cotton wool spots, hard exudates at the posterior pole in a case of PDR . Vision was 6/9.

Photographer: DR. TEJASWITA VERMA

Imaging device: MIRANTE

Condition/keywords: NEOVASCULARISATION OF DISC, proliferative diabetic retinopathy (PDR)

May 24 2024 by Anjana Mirajkar, MS Ophthalmology

A central photo of a 50 year old male case of PDR showing a sub-hyaloid hemorrhage with cotton wool spots , hard exudates at the fovea with dot and blot hemorrhages.

Photographer: Dr. Anjana Mirajkar -Retina Foundation, Ahmedabad

Imaging device: Mirante-Nidek

Condition/keywords: proliferative diabetic retinopathy (PDR), Sub hyaloid haemorrhage

Apr 28 2024 by Anjana Mirajkar, MS Ophthalmology

A widefield color photo of a 55 year old male case of supero-temporal BRVO showing venous tortuosity, cotton wool spots, flame shaped hemorrhages and macular edema.

Photographer: Dr. Anjana Mirajkar -Retina Foundation, Ahmedabad

Imaging device: Mirante-Nidek

Condition/keywords: branch retinal vein occlusion (BRVO), ST BRVO

Apr 1 2024 by Dr Venkatasubramaniam G

Fundus photograph of a 55 yr old male with Florid disc edema Hemorrhage and dense cotton wool spots with ischemia.

Photographer: Venkatsubramaniam

Imaging device: Remedio fundus on phone

Condition/keywords: Central vein oclussion, Diabetic Retinopathy

Apr 1 2024 by Dr Venkatasubramaniam G

Fundus photograph of a 55 yr old male with Florid disc edema Hemorrhage and dense cotton wool spots with ischemia.

Photographer: Venkatasubramaniam

Imaging device: Remedio fundus on phone

Condition/keywords: Central vein oclussion, diabetic retinopathy

Oct 19 2023 by Gabriel Costa Andrade, PhD

53-year-old woman with an acute CRVO. The patient has a history of breast cancer undergoing treatment with systemic chemotherapy. Notice the peripapillary cotton wool spots, superficial flame shaped hemorrhages and deeper dot and blot hemorrhages in all 4 quadrants.

Photographer: Gabriel Andrade

Condition/keywords: central retinal vein occlusion (CRVO), macular edema, Retina

Sep 26 2023 by Ben Serar

Fundus Photograph of RE showing superficial retinal haemorrhages ,with cotton wool spots, along the inferotemporal vessel arcade, in a case of inferotemporal branch retinal vein occlusion.

Condition/keywords: branch retinal vein occlusion (BRVO)

Sep 21 2023 by Ben Serar

Fundus photograph of RE showing retinal edema and opacification along the inferotemporal vessel arcade, with cotton wool spots and flame shaped haemorrhage, in a case of Branch Retinal Artery Occlusion (BRAO).

Condition/keywords: branch retinal artery occlusion (BRAO)

Sep 12 2023 by Ben Serar

Fundus photograph showing Disc edema, with splinter haemorrhages and cotton wool spots.

Condition/keywords: disc edema, splinter haemorrhages

Sep 12 2023 by Ben Serar

Fundus photograph showing Disc edema, with splinter haemorrhages and cotton wool spots.

Condition/keywords: disc edema, splinter haemorrhages

Sep 12 2023 by Ben Serar

Fundus Photograph of RE showing superficial retinal haemorrhages, with exudates at the macula, with cotton wool spots, with venous engorgement along the inferotemporal vessel arcade, in a case of inferotemporal branch retinal vein occlusion.

Condition/keywords: branch retinal vein occlusion (BRVO)

Sep 12 2023 by Ben Serar

Fundus photograph of the LE showing arterial occlusion along the inferotemporal vessel arcade with surrounding retinal edema and cotton-wool spots, in a case of Branch Retinal Artery Occlusion (BRAO).

Condition/keywords: branch retinal artery occlusion (BRAO), cotton wool spots, retinal edema

Sep 25 2021 by Denis Jusufbegovic, MD

27-year-old woman with a history of systemic lupus erythematosus (SLE) presented with decreased vision to counting fingers at 2’ in the right eye. Funduscopic examination of the right eye (A) demonstrated retinal thickening and whitening of the macula, numerous cotton-wool spots, intra-retinal hemorrhages, sclerotic vessels, and vascular sheathing. Fluorescein angiography (B) demonstrated extensive vessel wall leakage (red asterisk) and large areas of capillary non-perfusion (white asterisk). These findings were consistent with severe vaso-occlusive retinopathy, a serious ophthalmologic manifestation of SLE. She was also diagnosed with concomitant cerebral lupus vasculitis. She was treated with intravenous methylprednisolone followed by oral prednisone taper and aspirin therapy. Mycophenolate mofetil was titrated to 1500 mg twice daily. Upon follow-up vision improved to 20/200.

Imaging device: Zeiss Clarus 500

Condition/keywords: cerebral lupus vasculitis, cotton wool spots, systemic lupus erythematosus (SLE) vasculitis, vaso-occlusive disease

Aug 10 2020 by RITESH VERMA

Fundus photograph of a 27-year-old male with multiple cotton wool spots and hemorrhages in NF layer 6 days post roadside accident.

Photographer: Dr. Ritesh Verma, Regional institute of Ophthalmology, Rohtak, Haryana, India

Imaging device: CR-2AF CANON

Condition/keywords: cotton wool spots, hemorrhage

Nov 5 2019 by Chinmayi Vyas

Anemic retinopathy related retinal hemorrhages in a 24 years old male with Hb of 4.2gm/ dl. The manifestations of anemic retinopathy are nonspecific and may closely simulate hypertensive or diabetic retina. Retinal changes in anemia are cotton wool spots, venous tortuosity, and hemorrhages which may be present at all levels of the retina and choroid. All retinal hemorrhages can occur when Hb falls below 8 g/100 ml or if the platelet count falls below 50,000/cumm. The combination of severe anemia and thrombocytopenia is likely to produce retinal hemorrhages. The Roth’s spots or white centre hemorrhages are typically associated with bacterial endocarditis , anemia and other systemic conditions. The white center is suspected to represents focal ischemia, inflammatory or infectious infiltrate, fibrin or accumulation of neoplasticism cells.

Photographer: Dr Chinmayi Vyas, Nethradhama superspeciality eye hospital , banglore, india

Imaging device: Eidon fundus imaging

Condition/keywords: anaemic retinopathy

Nov 5 2019 by Chinmayi Vyas

Anemic retinopathy related retinal hemorrhages in a 24 years old male with Hb of 4.2gm/ dl. The manifestations of anemic retinopathy are nonspecific and may closely simulate hypertensive or diabetic retina. Retinal changes in anemia are cotton wool spots, venous tortuosity, and hemorrhages which may be present at all levels of the retina and choroid. All retinal hemorrhages can occur when Hb falls below 8 g/100 ml or if the platelet count falls below 50,000/cumm. The combination of severe anemia and thrombocytopenia is likely to produce retinal hemorrhages. The Roth’s spots or white centre hemorrhages are typically associated with bacterial endocarditis , anemia and other systemic conditions. The white center is suspected to represents focal ischemia, inflammatory or infectious infiltrate, fibrin or accumulation of neoplasticism cells.

Photographer: Dr Chinmayi Vyas

Condition/keywords: retinal hemorrhage

Apr 1 2019 by Gary R. Cook, MD, FACS

62-year-old white female with multiple cotton wool spots and intraretinal hemorrhages OD secondary to multiple myeloma; V.A. = 20/60+1.

Imaging device: Topcon VT-50

Condition/keywords: blot hemorrhages, cotton wool spots, myeloma, retinal hemorrhage, retinopathy

Mar 27 2019 by Gary R. Cook, MD, FACS

Right eye of a 56-year-old white male with a combined perfused CRVO (venous dilation and dot & blot hemorrhages in all 4 quadrants) and a superotemporal BRAO with peripapillary hemorrhages and cotton wool spots, and an area of retinal whitening inside of the ST arcade. V.A.= 20/70.

Imaging device: Topcon VT-50

Condition/keywords: branch retinal artery occlusion (BRAO), central retinal vein occlusion (CRVO)

Mar 26 2019 by Gary R. Cook, MD, FACS

62-year-old white female with multiple CWS and intraretinal hemorrhages OS secondary to multiple myeloma; VA= 20/20-2.

Imaging device: Topcon VT-50

Condition/keywords: blot hemorrhages, cotton wool spots, myeloma, retinal hemorrhage

Aug 23 2018 by Nichole Lewis

Cotton Wool Spots

Photographer: Nichole Lewis

Condition/keywords: cotton wool spots

Jul 10 2018 by Deepak Bhojwani, MS

Colour fundus montage image of a 33-year-old young lady with history of Systemic Lupus Erythematosus of 6 years showing classic SLE retinopathy with multiple cotton wool spots , few haemorrhages and multiple small vessel sheathing s/o SLE vasculitis.

Photographer: Deepak Bhojwani

Condition/keywords: systemic lupus erythematosus (SLE) retinopathy, systemic lupus erythematosus (SLE) vasculitis

Apr 23 2018 by Frank Chin

Fundus photograph of the right eye of a 24-year-old woman with history of systemic lupus erythematosus who presented with decreased visual acuity for 2-3 days found to have lupus hemorrhagic occlusive vasculitis with mild disc elevation, diffuse punctate cotton wool spots and dot blot hemorrhages, and a hemorrhage occlusive vasculitis along the superior branch of the superotemporal arcade involving the artery and vein.

Photographer: Frank Chin, MD, George Washington University

Imaging device: Optos 200Tx

Condition/keywords: blot hemorrhages, cotton wool spots, occlusive vasculitis, systemic lupus erythematosus (SLE) vasculitis

Oct 19 2017 by Nichole Lewis

Fundus photography of a 41-year-old male with hypertensive retinopathy, disc edema, cotton wool spots, subretinal hemorrhage and lipid. BP 136/79

Photographer: Nichole Lewis

Condition/keywords: cotton wool spots, disc edema, hypertensive retinopathy, lipid, subretinal hemorrhage

Oct 19 2017 by Nichole Lewis

Fundus photography of a 41-year-old male with hypertensive retinopathy, disc edema, cotton wool spots, Subretinal hemorrhage and lipid. BP 136/79.

Photographer: Nichole Lewis

Condition/keywords: cotton wool spots, disc edema, hypertensive retinopathy, lipid, subretinal hemorrhage