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Park, Cho, Park, and Ohn: A Single Isolated Cotton-Wool Spot not Associated with Systemic Diseases
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(12): 1898-1903.

Published online: 17 December 2012

DOI: https://doi.org/10.3341/jkos.2012.53.12.1898

A Single Isolated Cotton-Wool Spot not Associated with Systemic Diseases

Sae Mi Park, MD, In Hwan Cho, MD, Tae Kwann Park, MD, PhD, Young Hoon Ohn, MD, PhD

Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Address reprint requests to Young Hoon Ohn, MD, PhD. Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, #170 Jomaru-ro, Wonmi-gu, Bucheon 420-767, Korea. Tel: 82-32-621-5425, Fax: 82-32-621-5435, yhohn@schmc.ac.kr

Received 25 April 2012       Accepted 19 October 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To present a case of a single isolated cotton-wool spot in a healthy patient.

Case summary

A 43-year-old woman with no systemic disease complained of sudden inferior field defect of the right eye. On fundoscopic examination of the right eye, a single soft white spot was observed in the superotemporal vascular arcade. An elevated hyper-reflective area in the inner retina corresponding to a white spot was observed on optical coherence tomography. Automated perimetry revealed an arcuate field defect which was wider than the cotton-wool spot. A complete workup for systemic diseases was within normal range except a positive rheumatoid factor. At the 2-week follow-up, the patient's subjective symptom improved and the white spot decreased. After 6 months, the cotton-wool spot disappeared and slit-like retinal nerve fiber layer (RNFL) defects corresponding to the location of the cotton-wool spot was noticed. One year later, disc and RNFL defect were unchanged but the previous field defect disappeared.

Conclusions

Isolated cotton-wool spots can occur without serious systemic diseases in healthy patients. A single isolated cotton-wool spot in the present case disappeared spontaneously leaving permanent structural damage on the retina over time.

Keywords: Cotton-wool spot, Retinal nerve fiber layer defect, Systemic disease

Figures and Tables

Figure 1
Initial fundus photographs showed the cotton wool spot in the right eye (A) and localized slit-like retinal nerve fiber layer (RNFL) defects in the left eye (B). RNFL thickness analysis by SD-OCT showed normal range of mean RNFL thickness in both eyes but deflection of RNFL thickness curve at the superior temporal area corresponding to the localized RNFL defect in the left eye was noticed (red circle). Static automated perimetry (SAP) of the right eye at the initial visit showed a focal defect which was located posterior to the location of cotton wool spot (orange circle) and the SAP of left eye was within normal limits.
jkos-53-1898-g001
Figure 2
Fluorescein angiography at the initial visit. In early phase, focal filling defect in the region of the cotton wool spot was seen and mild hyperfluorescence surrounding the cotton wool spot appeared as time went.
jkos-53-1898-g002
Figure 3
Serial fundus photographs and optical coherence tomography (OCT) scans taken at the initial visit, 1 month and 1 year later. A single white spot was seen in the temporal superior arcade (arrow) of the right eye (A). Fundus photograph 1 month later (B) showed a reduced cotton wool spot (arrow). One year later, the spot disappeared and localized slit-like retinal nerve fiber layer defect which did not reach the disc margin was noticed instead (C). OCT linear scan transversing the cotton wool spot showed elevated hyper-reflective area in the inner retina (D). But 1 month later, decreased hyper-reflective area in the inner retina was noticed (E). The smaller hyper-reflective area in the inner retina was seen, indicative of inner retinal gliosis but almost normal retinal structure was restored 1 year later (F).
jkos-53-1898-g003

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