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What Are Roth Spots?

Medically Reviewed by Dan Brennan, MD on June 29, 2021

A Roth spot, also known as a Litten spot, is a hemorrhage — the release of blood from a ruptured blood vessel — in the retina. The retina is the part of the eye that senses light and sends visual information to your brain, allowing you to see.  

Roth spots are only visible during an eye exam. While they don’t always cause vision problems, they can be a sign of diseases such as leukemia, diabetes, and endocarditis.

What Do Roth Spots Look Like?

During an eye examination, a Roth spot may appear on your retina as a red, flame-shaped spot with a white dot at the center. These spots are typically found at the posterior pole of the eye or the back of the eye.

The white spot is made of fibrin — a protein that works to “plug” the rupture and stop the bleeding. If the white dot isn’t present, the condition is considered a retinal hemorrhage. Roth spots themselves typically don’t cause any kind of visual impairment.

Roth Spots and Endocarditis

Moritz Roth, a Swiss physician, first described Roth spots in 1872. An early study in 1878 reported that these white-centered hemorrhages were present in 80% of cases associated with bacterial endocarditis. To this day, they’re most commonly associated with endocarditis. 

However, later studies found that Roth spots are the least common physical symptom of endocarditis — present in only 2% of patients with endocarditis. 

While Roth spots are still considered a potential sign of bacterial endocarditis, they aren’t a primary symptom. Roth spots have since been linked to a variety of different medical conditions.

What Causes Roth Spots?

Roth spots occur in a variety of diseases or conditions where there is retinal blood vessel injury. 

White-centered hemorrhages are common in cases associated with diabetes. One study found that out of 215 diabetic patients with retinopathy, 15.6% had at least one white-centered retinal hemorrhage, while another 4.9% had five or more.

Roth spots can occur in other conditions like: 

Testing and Diagnosis for Roth Spots

Roth spots are typically diagnosed during an eye examination. Your physician or optometrist may give you a fundoscopic exam, which involves the use of a scope with a magnifying lens and a light to examine the retina and the blood vessels. 

After identifying Roth spots, your optometrist may recommend additional testing, including an assessment for hypertension, a glucose test, and a complete blood count. These tests can help identify some conditions that may be behind the hemorrhaging, including diabetes, hypertension, and more. Additional tests can include blood cultures and cardiac evaluation.

Treatment for Roth Spots

As Roth spots can be caused by a variety of conditions, there’s no single treatment for them. If your doctor identifies Roth spots in your retina, they will likely refer you to other relevant specialists to narrow down the cause. The goal of treatment will be to resolve the underlying condition that caused the Roth spots. Once the underlying condition is treated, the spots should go away on their own. 

Since Roth spots typically aren't painful and they don’t disrupt your vision, you may not even realize you have them. Regular eye examinations will allow your doctor to diagnose any potential issues as early as possible. 

If you’re experiencing symptoms like fever, chest pain, and shortness of breath, this may be a sign of endocarditis. You should see a doctor as soon as possible for treatment.

Show Sources

SOURCES:

The Eyes Have It: "Roth Spot."

Mayo Clinic: "Retinal Diseases."

Ophthalmology: "White centered retinal hemorrhages in diabetic retinopathy."

Review of Optometry: "Spot the Dot."

Stanford Medicine: Fevers, mild confusion and this retinal finding… Diagnosis?"

StatPearls: "Roth Spots."

QJM: An International Journal of Medicine: "Classical eye signs in bacterial endocarditis."

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