Exudates and Cotton Wool Spots

Presenting Symptom: Cotton wool spots. Pathology: Papilledema with exudate. Clinical: Characteristically true exudates appear as punctate yellow spots which, in the present case, predominate in the area between the macula and the disc. They are situated relatively deep in the retina and contrast in size and color with the superficial cotton wool spots which - in this slide - are situated along the inferior retinal vessels. Exudates occur whenever the retinal vessels become abnormally leaky; they are not specific. Other notable features in this case are the severe narrowing of the arteries, the blurring of the disc edges (papilledema) and the concentric wrinkles of the retina on the temporal side of the swollen disc. The patient was a 28-year old male with severe hypertension (BP 220/170). Disease/ Diagnosis: Hypertensive retinopathy.