Hollenhorst plaques are bright, refractile cholesterol emboli seen in retinal arteries, usually at branch points. They typically originate from atherosclerotic carotid or aortic plaques.
Clinical importance
Most plaques do not cause major retinal damage but signal systemic vascular risk.
- Often found incidentally during routine fundus exam
- May associate with transient visual loss or branch artery occlusion
- Indicate increased risk of stroke and cardiovascular events
- Common in older patients with hypertension or hyperlipidaemia
Management
Care focuses on systemic evaluation and risk-factor modification.
- Referral for carotid imaging and cardiovascular assessment
- Aggressive control of blood pressure, lipids, diabetes, and smoking
- Antiplatelet therapy where appropriate after medical review
- Ophthalmic follow-up if associated occlusions or ischaemia are present
