Soft exudates, also known as cotton wool spots, are associated with which pathology?

Soft exudates, also known as cotton wool spots, are associated with which pathology?

• A. Gray/white lesions due to hemorrhage
• B. Ischemia and infarction of the superficial retinal nerve fibers
• C. Lipid leakage from capillaries
• D. Choroidal neovascularization

Answer: (B)

Cotton wool spots arise from ischemia of the superficial retinal nerve fiber layer. When small vessels supplying this layer become occluded, axoplasmic flow in the nerve fibers is disrupted, leading to swelling and a fluffy, pale patch in the retina. This reflects microinfarcts and is commonly seen in ischemic conditions like diabetic and hypertensive retinopathy. They’re not due to hemorrhage, lipid leakage, or choroidal neovascularization—the latter two produce hard exudates and neovascular growth, respectively.

Cotton wool spots arise from ischemia of the superficial retinal nerve fiber layer. When small vessels supplying this layer become occluded, axoplasmic flow in the nerve fibers is disrupted, leading to swelling and a fluffy, pale patch in the retina. This reflects microinfarcts and is commonly seen in ischemic conditions like diabetic and hypertensive retinopathy. They’re not due to hemorrhage, lipid leakage, or choroidal neovascularization—the latter two produce hard exudates and neovascular growth, respectively.