Hard Exudates

• Hard exudates can be seen in any conditions that are associated with chronic vascular leakage , such as:
  • Diabetic retinopathy
  • Hypertensive retinopathy
  • Coat's disease
  • Capillary hemangioma of the retina
  • Choroidal neovascularization
  • Retinal arterial macroaneurysm

Mechanism

• Increased vascular permeability allowing the leakage of fluid and lipoprotein into the retina resulting in thickening of the macula
• Resorption of the edema commonly results in precipitation of lipid residues within the outer plexiform (Henle's) layer

Clinical Features

• Symptoms: various degree of decreased vision if involving the macula
• Signs:
  • Discrete white-yellow lipid deposits in the posterior pole
  • Commonly seen in a circinate pattern peripheral to the areas of leakage
  • May present as large, confluent exudation
  • Macular star and/or circumpapillary hard exudates can be seen in Leber's stellate neuro-retinitis or end-stage hypertensive retinopathy

Management

• Treat the underlying diseases