Population screening for sight threatening diseases based on fundus imaging is in place or being considered worldwide. Most existing programs are focussed on a specific disease and are based on manual reading of images, though automated image analysis based solutions are being developed. Exudates and drusen are bright lesions which indicate very different diseases, but can appear to be similar. Discriminating between them is of interest to increase screening performance. In this paper, we present a Bag of Words approach which can be used to design a system that can play the dual role of content based retrieval (of images with exudates or drusen) system and a decision support system to address the problem of bright lesion discrimination. The approach consists of a novel partitioning of an image into patches from which colour, texture, edge and granulometry based features are extracted to build a dictionary. A bag of words approach is then employed to help retrieve images matching a query image as well as derive a decision on the type of bright lesion in the given (query) image. This approach has been implemented and tested on a combination of public and local dataset of 415 images. The area under the curve for image classification is 0.90 and retrieved precision is 0.76.