The retinal manifestations of Rocky Mountain spotted fever

The prominent ophthalmoscopic features in a 9-year-old white girl with Rocky Mountain spotted fever consisted of papilledema, cotton-wool spots, and dilated, tortuous retinal veins. Fluorescein angigography showed focal areas of capillary nonperfusion with blocked retinal and choroidal fluorescence at the cotton-wool spots. We observed perivascular staining adjacent to the infarcted areas. In addition to hyperfluorescence of the optic disks, late phase photographs demonstrated prolonged retention of intravascular fluorescein indicating obstruction to venous outflow.