Can cotton-wool spots be idiopathic?

[iriss]

I was diagnosed with Graves Disease a month ago and I will see the endocrinologist next month, so I haven't been treated yet. Today I saw my opthamologist and she said I have 2 cotton-wool spots in one of my eyes. She was vague about what causes this, but said diabetes or high blood pressure (and I have neither..my physical was 2 months ago).  I did some research and see that AIDS can cause this, so I panicked and called the eye doctor.  She said since I am married for 16 years monogamous for 17 years, she highly doubts I have AIDS. I never in my life took any illegal drugs (by mouth or IV).  I came down with pneumonia a year ago which immediately began subsiding after 24 hours on an antibiotic.
The eye doctor said she has about 5 people in her practice who have these cotton wool spots for no apparent reason. She wants me to see her again in 3 months and if I still have them, she will recommend a full work up.
Please, I am freaking out. What can these cotton wool spots be from?  Can you list all the possible reasons? Thanks

[Kevin Pho, MD]

Cotton-wool spots are tiny white areas on the retina, the layer of light-sensing cells lining the back of the eye. Caused by a lack of blood flow to the small retinal blood vessels, they usually disappear without treatment and do not threaten vision. They can, however, be an indication of a serious medical condition.

Diabetes and hypertension are the most common causes of cotton-wool spots. The presence of more than eight cotton-wool spots has been associated with a higher risk of the more severe form of diabetic retinopathy known as proliferative diabetic retinopathy.

Cotton-wool spots are also a common sign of infection with the Human Immunodeficiency Virus (HIV). They are present in more than half of the people with full-blown AIDS. Their presence can be an important sign of the severity of HIV-related disease.

If everything is negative, I would suggest periodic eye exams.  Often cotton wool spots will disappear on their own, but new ones may occur because the underlying condition may continue to cause blood flow problems.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[iriss]

I forgot to mention that I have a history of mitral valve prolaps diagnosed by echocardiogram about 20 years ago.

[tbd]

While doing Google searches on cotton-wool spots for myself (recent diagnosis) I noticed your follow-up comment about mitral valve prolapse after the initial response posted.  I didn't see a follow-up to this information, so  I though I would let you know that some of the information I've seen does indicate mvp is potentially connected to the development of cotton wool spots.  

I am not medically trained.  Just an engineer trying to understand my own situation by doing some research to educate myself.

As I'm understanding it, the CWS's can be caused by a variety of things.  One of which is any condition that could create an emboli that would travel to the tiny arteries or veins in the eye and restrict proper blood flow to the retina tissue.   The emboli can be of many types (i.e. cholesterol plaque, calcification plaque, talc, clotting, etc.).  A few articles I've seen seem to indicate that the blood flow irregularity associated w/ mvp may be responsible for the formulation of the emboli (i.e. clotting?).  See the following site:  http://www.nova.edu/~jsowka/vascocc.html

There seem to be a whole host of other things that can cause the cws's incl. autoimmune diseases (i.e. HIV, Lupus, etc.) and inflammatory diseases.  Have also seen anemia, leukemia and syphilis.

I hope your situation has been resolved since your posting in '03.

I am currently awaiting test results (blood, MRI, carotid doppler, etc.) Papillophlebitis (http://www.revoptom.com/handbook/SECT43a.HTM)is the condition that seems to fit what I know about myself.I am a fit 37 year-old, caucasian male, monogomous & married for 15 years, non-smoker, non-drinker, no family history of stroke, diabetes, or hypertension.  I developed a single cotton-wool spot on the edge of my macula 3 weeks ago.