Comments of Hua Gao, M.D. This patient has acute hypertensive retinopathy in both eyes accompanied by moderate non-proliferative diabetic retinopathy.  On further examination the systemic blood pressure was noted to be 180/100 at the clinic.  In a case like this, the primary care physician should be consulted for management of the hypertension. The cotton wool spots in the para arcade area, flame shaped hemorrhages, and disc edema all indicate hypertensive retinopathy. Patients who present like this with clinically significant macular edema (present in the right eye of this patient) can benefit from focal laser treatment to the affected area. As the hypertensive retinopathy is brought under control, the cotton wool spots (local infarcted areas in the nerve fiber layers) would be expected to dissapear in a few weeks.  In addition, the macular edema can be controlled by the focal laser.  These conditions are reversible in a relatively short period after appropriate treatment. The clinical picture in the patient described here is an acute process.  If this were a chronic process, one would expect arterial attenuation, intraretinal hemorrhage with the chronic hypertensive retinopathy.  In chronic cases the cotton wool spots and optic nerve edema are not commonly seen. This patient represents the common co-existence of diabetic retinopathy and acute hypertension.  - --