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Retinal Hard Exudates

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Ophthalmic Signs in Practice of Medicine

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Abstract

Deposition of hard exudates in the retina indicates a breakdown in the blood-retinal barrier with the leakage of plasma and macromolecules. The presence of retinal hard exudates may be the only easily discernible retinal sign of an underlying systemic disease, the most common of which are diabetes of at least 5 years and hypertension. The severity of hard exudates in diabetes correlates with plasma low-density lipoproteins and triglycerides. The presence of retinal hard exudates may be a surrogate for atherosclerosis in diabetics. The use of statins in patients with diabetes may dramatically reduce the severity of retinal hard exudates. It may serve as a biomarker for the efficacy of statins.

Several sight-threatening retinal disorders, including retinal vascular occlusions, retinal vascular inflammations, and retina tumours, may also result in the deposition of hard exudates. These must be differentiated from cotton wool spots (soft exudates) and retinal drusen. The availability of optical coherence tomography has enabled us to see the forme fruste of hard exudates as hyperreflective foci (HF) in various retina layers. These represent the phagocytosis of the leaked lipoproteins by the retinal microglia, the resident phagocytic cells. HF migrate through the retina, but the fats are deposited as irregular shiny aggregates once they rupture.

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Authors and Affiliations

  1. Advanced Eye Centre, Chandigarh, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Amod Gupta & Arun Kapil

  2. Advanced Eye Centre, Chandigarh, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

    Reema Bansal

  3. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Aman Sharma

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Gupta, A., Bansal, R., Sharma, A., Kapil, A. (2023). Retinal Hard Exudates. In: Ophthalmic Signs in Practice of Medicine. Springer, Singapore. https://doi.org/10.1007/978-981-99-7923-3_4

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