Cotton wool spots as the only fundoscopic manifestation of giant cell arteritis: A scoping review.

Abstract

Introduction: This study aimed to review and describe isolated cotton wool spots (CWS) on retinal examination in patients with systemic or occult presentation of giant cell arteritis (GCA).

Material and methods: In this scoping review, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews, PubMed, Scopus, and Web of Science were searched for peer-reviewed articles reporting an association between GCA and CWS from 1960 to 13^th of June 2026. Case reports and case series of confirmed GCA with CWS as the sole fundoscopic finding were included. Data were charted independently by two reviewers using a standardized Excel extraction form.

Results: Sixteen articles, including fifteen case reports and one case series, were included in the study. 76.19% of patients had concurrent systemic symptoms, while the remaining 23.81% had an occult presentation. Patients with occult GCA tended to be younger at presentation compared with those with systemic disease. No difference in inflammatory markers was observed between the occult and the systemic presentation of the disease.

Conclusion: This review summarizes the current evidence and characteristics of CWS as an isolated retinal manifestation of GCA. The included evidence suggests that this atypical presentation may occur even in the absence of systemic symptoms, highlighting the importance of early clinical recognition, as delayed diagnosis may lead to irreversible visual loss.