These are pictures of Age-related macular degeneration. This is part in Fundoscopic findings of the Atlas of Emergency Medicine book
Clinical Summary
Hard exudates are refractile, yellowish deposits with sharp margins composed of fat-laden macrophages and serum lipids. Occasionally the lipid deposits form a partial or complete ring (called a circinate ring) around the leaking area of pathology. If the lipid leakage is located near the fovea, a spoke or star-type distribution of the hard exudates may be seen.
Cotton wool spots, or soft “exudates,” are actually microinfarctions of the retinal nerve fiber layer, and appear white with soft or fuzzy edges.
Inflammatory exudates are secondary to retinal or chorioretinal inflammation.
Hard exudation and cotton wool spots are associated with vascular diseases such as diabetes mellitus, hypertension, and collagen vascular diseases but can be seen with papilledema and other intrinsic ocular conditions. Inflammatory exudates are seen in patients with such diseases as sarcoidosis and toxoplasmosis.
Management and Disposition
Routine referral for ophthalmologic and medical workup is appropriate.
Pearl
1. Hard exudates that are intraretinal may easily be confused with drusen occurring near Bruch membrane, which separates the retina from the choroid.
FIGURE 3.5 ■ Hard Exudates. Linear collection of yellow lipid
deposits with sharp margins in macula.
deposits with sharp margins in macula.
FIGURE 3.6 ■ Cotton Wool Spots. White lesions with fuzzy margins,
seen here approximately one-fifth to one-fourth disk diameter
in size. Orientation of cotton wool spots generally follows the curvilinear
in size. Orientation of cotton wool spots generally follows the curvilinear
arrangement of the nerve fiber layer. Intraretinal hemorrhages
and intraretinal vascular abnormalities are also present.
and intraretinal vascular abnormalities are also present.
REFERENCES
The Atlas of Emergency Medicine, Fourth Edition, 2016.
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