Patients with branch retinal artery occlusion and central retinal vein occlusion present with which classic physical exam finding?

• A. Cotton wool spots
• B. Cherry-red spot
• C. Retinal hemorrhages
• D. Optic disc pallor

Answer: (A)

Ischemia drives the classic fundoscopic finding seen with retinal vascular occlusions. Cotton-wool spots are tiny infarcts of the nerve fiber layer caused by reduced blood flow, and they appear as fluffy white patches on examination. This sign reflects retinal ischemia that can occur with both branch retinal artery occlusion and central retinal vein occlusion, highlighting the shared consequence of impaired perfusion to retinal tissue.

A cherry-red spot is the hallmark of acute retinal artery occlusion like CRAO, where the surrounding ischemic retina becomes pale but the fovea remains red due to intact choroidal circulation, so it’s not the typical finding in BRVO/CRVO. Retinal hemorrhages do occur with CRVO and can be prominent, but cotton-wool spots specifically point to ischemic change in the nerve fiber layer. Optic disc pallor tends to be a later sign of chronic or optic neuropathy rather than an acute, classic presentation.