What Are Roth Spots?

Roth spots are named after Moritz Roth, who discovered them in 1872 on a patient with bacterial endocarditis, the inflammation of the heart’s lining. 

While Roth spots themselves do not pose a health risk, they are usually a symptom of a more serious systemic illness. This article discusses the causes of Roth spots, risk factors, treatment, and commonly asked questions.

What Are Roth Spots?

Roth spots are white-centered retinal hemorrhages that show up as spots on a retinal scan of the back of the eye. They result from a rupture of the small capillaries in the retina (a layer of cells in the back of the eye that senses light).

Roth spots are a type of retinal hemorrhage, which is a secondary symptom of a variety of underlying medical conditions, including:

• Infective endocarditis
• Diabetes mellitus
• Leukemia
• Retinopathy (hypertensive and diabetic)
• Anemia
• Preeclampsia
• Anoxia (loss of oxygen to the brain)
• Ocular diseases 

Roth spots are typically asymptomatic and may come and go. They might be discovered during a routine eye exam. People with systemic disease may also be referred to an eye doctor to check for ocular complications.

What Do Roth Spots Look Like?

Roth spots are found in the retinal nerve fiber layer (RNFL). They present as round red spots with a white center.

The round spot on the retinal layer is created from the leakage of blood and fluid from a retinal capillary rupture. The white centers are caused by a fibrin platelet plug that forms to stop bleeding.

While the white-centered hemorrhage is not a serious health concern, it can be a sign of a severe medical condition. Roth spots typically do lead to visual disturbances. 

What Causes Roth Spots?

The most common cause of Roth spots is subacute bacterial endocarditis, with 2% of people diagnosed with the condition also developing Roth spots.²

Other common causes of Roth spots include:

• Infective endocarditis
• Diabetes mellitus
• Leukemia
• Retinopathy (hypertensive and diabetic)
• Anemia
• Preeclampsia
• Anoxia (loss of oxygen to the brain)
• Ocular diseases 
• High blood pressure 
• Human Immunodeficiency Virus (HIV)
• Shaken baby syndrome intracranial hemorrhage

Do Roth Spots Indicate Underlying Conditions?

Yes. Roth spots are typically a sign of underlying systemic disease. Underlying medical conditions that lead to the fragility of blood vessels and capillaries make a hemorrhage or rupture more likely.

Medical conditions that affect blood vessels and capillaries that can lead to Roth spots include:

• Endocarditis
• Diabetes
• Anemia
• Leukemia
• Hypertension
• Heart disease

Roth Spots and Retinal Hemorrhages

Roth spots are a type of retinal hemorrhage typically located on the nerve fiber layer of the retina. Retinal hemorrhages are a clue to underlying vascular disease. They should be followed up with a medical workup to find the root cause.

Abnormal blood work and the location and shape of the hemorrhage can help determine the cause. Abnormal blood counts can indicate leukemia, anemia, thrombosis, and other vascular conditions.

Symptoms of a retinal hemorrhage may include:

• Sudden vision loss
• Blurry vision
• Floaters
• Flashes of light
• Blind spots

Detection and Diagnosis of Roth Spots

Roth spots are usually asymptomatic and typically discovered during a routine comprehensive eye exam. They’re more likely to be detected if the exam includes a fundoscopic examination to look at the back of the eye and retina.

Since the presence of Roth spots indicates systemic disease, the exam should be followed up with a detailed medical history and physical exam, including blood work, to find the root cause of the Roth spots.

What is the Role of Patient History in Diagnosis?

A detailed patient history and thorough physical exam are essential to finding and treating the root cause of Roth spots. After diagnosing Roth spots on a retinal scan, the eye doctor should refer or coordinate with a medical doctor to obtain further testing.

Exams and tests should look for the following:

• Vital signs (blood pressure, temperature, oxygen level, heart rate)
• Look for signs of infection (chills, fever, night sweats)
• Unexplained weight loss
• Abnormal bleeding or bruising
• Complete blood count
• Assess skin for lesions
• Fatigue
• Blood cultures
• Cardiac murmurs
• HIV antibody testing
• Abnormal blood work
• Respiratory abnormalities

How are Roth Spots Treated?

Roth spots will usually disappear on their own after diagnosing and treating the underlying disease process. Sometimes, they will resolve on their own without intervention.

Treatment options may include:

• Antibiotics for endocarditis or an infection
• Chemotherapy for leukemia or other blood cancers
• Adjust insulin doses for people with diabetic retinopathy
• Blood pressure medication hypertensive retinopathy
• Iron supplements for anemia

Long-Term Implications of Roth Spots

The implications of Roth spots depend on their underlying cause, ranging from minor (anemia) to severe (leukemia or other blood cancers). 

If you are having trouble with your vision or have symptoms of an eye hemorrhage, it is also important to see an eye doctor right away to rule out systemic disease.

Management Strategies for Roth Spots

Routine follow-up with your doctor and ophthalmologist is vital to managing Roth spots and ensuring you are treated for any underlying conditions.

This will also help prevent vision complications if systemic disease is left untreated.

Summary

Roth spots are retinal hemorrhages often associated with underlying medical conditions such as endocarditis, leukemia, retinopathy, hypertension, and anemia. They appear as round spots with a white center on a retinal exam.

A diagnosis of Roth spots should be followed up with an extensive medical and physical exam to determine the root cause of the hemorrhage. Treatment, management, and potential complications depend on the underlying systemic condition.