A 53-year-old woman with severe arterial hypertension was concerned about flashes and a shadow in her left eye. Perimetry revealed an arc-shaped visual field defect in the superior hemisphere. Ophthalmoscopy showed a large cotton-wool spot inferior of the optic disc (Figure 1, above). Optical coherence tomography showed an edema of the retinal nerve fiber layer in the area of the cotton-wool spot. One year later, perimetry was unchanged. On ophthalmoscopy, an inferior wedge-shaped defect of the retinal nerve fiber layer was detected (Figure 2A, right, white arrows), while the cotton-wool spot completely vanished. Optical coherence tomography revealed a marked reduction in the retinal nerve fiber layer thickness in the corresponding region (Figure 2B, black arrows; Figure 2C, green area). Consequences of severe arterial hypertension in the retina can be detected long after cotton-wool spots vanish by optical coherence tomography showing localized retinal nerve fiber layer defects. G indicates global; ILM, internal limiting membrane; INF, inferior; N, nasal; NAS, nasal; NI, nasal inferior; NS, nasal superior; RNFL, retinal nerve fiber layer; RNFLT, retinal nerve fiber layer thickness; SUP, superior; T, temporal; TI, temporal inferior; TMP, temporal; and TS, temporal superior.
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