“Candle-wax spots” in the retina are present in
**Core Concept**
"Candle-wax spots" are characteristic retinal lesions seen in sarcoidosis, representing retinal pigment epithelial (RPE) nodules due to granulomatous inflammation. These spots result from the deposition of immune complexes and granulomas in the retina, often associated with systemic sarcoidosis.
**Why the Correct Answer is Right**
In sarcoidosis, granulomatous inflammation affects multiple organs, including the eyes. Retinal involvement manifests as well-demarcated, yellowish, round lesions resembling candle wax on fundoscopy. These are due to non-caseating granulomas in the retinal pigment epithelium, typically appearing in the macula or periphery. The lesions are often bilateral, symmetric, and associated with systemic symptoms like cough or fatigue.
**Why Each Wrong Option is Incorrect**
Option B: Toxoplasmosis causes retinal lesions with well-defined, white or yellowish, "candle wax" appearance, but these are typically seen in **toxoplasmosis** as **retinitis** with **retinal scars** and **halos**, not as discrete "candle wax spots." The classic presentation is **retinal necrosis** with **perivascular** or **peripheral** lesions, not isolated wax-like nodules.
Option C: Syphilis causes **retinal vasculitis** or **syphilitic retinitis**, with **retinal exudates**, **cotton wool spots**, and **retinal hemorrhages**, not candle-wax spots.
Option D: Tuberculosis may cause **retinal vasculitis** or **retinal necrosis**, but "candle-wax spots" are not a hallmark feature; TB retinal lesions are usually associated with **chronic inflammation** and **infiltrates**, not classic wax-like nodules.
**Clinical Pearl / High-Yield Fact**
Candle-wax spots are a **classic sign of sarcoidosis** and should prompt evaluation for systemic sarcoidosis, especially in patients with lung or lymph node involvement. Always consider sarcoidosis in any patient with bilateral, symmetric, non-painful retinal nodules.
✓ Correct Answer: A. Sarcoidosis