Isolated cotton-wool spots in a 67-year-old woman.

An elderly woman presented for evaluation of the recent onset of a fixed, blurry circle in the right eye. Visual acuity was 20/20 OU. Funduscopic examination revealed a newly-noticed isolated cotton-wool spot in each eye. Amsler grid testing revealed an arcuate shady area in the inferior nasal field. A thorough systemic and laboratory evaluation led to the diagnosis of multiple myeloma. The evaluation of an isolated cotton-wool spot found on funduscopic examination in the absence of diabetes and hypertension is discussed.