Dr. Don Steensma 465 W. Channel Islands Blvd, Port Hueneme, CA 805/486-3585

This young women was at risk for a stroke.

A 35 year hispanic women presents for a routine eye examination.  She wears contact lenses and simply needed more lenses.  General health was good.  She was not taking any medications and felt great.  The left eye was unremarkable.

Picture of eye with hypertension

This is a photograph of her right eye:  The white spot half way between her optic nerve and her macula is a "cotton-wool" spot.  This is a retinal infarction (an area of dead tissue from an inadequate blood supply - like a heart attack).  At it's top edge there are a few dots of blood.

Cotton-wool spots are sometimes seen in  collagen vascular diseases, cardiac valve disease and carotid artery disease.  A clot, plaque or emboli, break free and become lodged in the smaller blood vessels.  When the vessel becomes occluded, blood leaks out to create a retinal hemorrhage.  Poorly controlled diabetes can also lead to cotton-wool spots.  As the sugar level surges up and down, the vessel walls expand and become leaky.  Hypertension is another main cause of cotton-wool spots.  If the blood pressure is high enough, it will blow a hole in the blood vessel producing a hemorrhage.  The patient's blood pressure was 185/102.  This is hypertensive retinopathy.

Another interesting finding here is the dark band above the macula arcing through the cotton-wool spot to the optic nerve.  This is a neve-fiber defect caused by the hemorrhage.  Note the white lines below the macula arcing over to the optic nerve.  This is normal.  The dark band above are dead nerve fibers.

If the patient had the same event in her brain it would have lead to a stroke.  She is now on hypertension medications and is very glad she had an eye exam that day.

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