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Cotton wool spots in AIDS: a review

R Wilson1

  • 1New England College of Optometry, Beacon St., Boston, MA 02115.

Journal of the American Optometric Association
|February 1, 1994
PubMed
Summary

Cotton wool spots (CWS) are common in HIV/AIDS patients. While insignificant in healthy individuals, CWS indicate poor prognosis in advanced HIV disease with low CD4+ counts, requiring close monitoring.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Immunology

Background:

  • Cotton wool spots (CWS) are retinal nerve fiber layer infarctions observed in various conditions.
  • CWS are the most common ocular manifestation in patients with human immunodeficiency virus (HIV) disease and acquired immune deficiency syndrome (AIDS).

Purpose of the Study:

  • To discuss the etiology, pathophysiology, clinical significance, and management of CWS in patients with AIDS.
  • To synthesize current scientific data and clinical studies regarding CWS in the context of HIV/AIDS.

Main Methods:

  • Literature review and interpretation of scientific data and clinical studies.
  • Discussion of existing research on CWS in patients with AIDS.

Main Results:

  • A correlation exists between CWS, low CD4+ lymphocyte counts (< 50-100/mm3), HIV disease progression, and opportunistic infections.
  • CWS in HIV-positive individuals without advanced disease have minimal clinical significance.

Conclusions:

  • CWS in healthy HIV-positive patients generally have limited clinical significance.
  • CWS in patients with advanced HIV disease and very low CD4+ counts are a negative prognostic indicator.
  • The presence of CWS in profoundly immunosuppressed patients necessitates close patient monitoring by optometrists.

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