A 56-year-old woman with a history of cirrhosis secondary to hepatitis C (diagnosed in 2011), hypothyroidism, and anemia presented with 6 months of blurred vision in both eyes. Her home medication regimen consisted of ribavirin, rifaximin, lactulose, furosemide, spironolactone, peginterferon alfa-2a, and levothyroxine sodium. Corrected visual acuity was recorded as 20/40 OU. Her pupils, intraocular pressure, motility, and confrontational visual fields were normal in each eye. Anterior slitlamp examination demonstrated mild nuclear sclerotic cataracts in both eyes. Dilated fundus examination (Figure 1) demonstrated multiple peripapillary and macular cotton-wool spots in both eyes, dot hemorrhages in both eyes, peripapillary flame hemorrhage in the right eye, and a disc hemorrhage in the left eye.
Andreoli MT, Lim JI. Cotton-Wool Spots and Retinal Hemorrhages. JAMA Ophthalmol. 2014;132(4):503-504. doi:10.1001/jamaophthalmol.2014.198