What is Roth Spots?
White-centered spots in the back of the eye, known as Roth spots, were first identified by a Swiss doctor called Moritz Roth in 1872. Yet it wasn’t until 1878 that these spots were named “Roth spot” by another physician, Moritz Litten. He noted that he found these white-centered spots in the eyes of 80% of patients with a condition called subacute bacterial endocarditis, an infection of the heart’s inner lining.
Roth spots are most often found in patients with infective endocarditis, another type of heart infection. However, they can appear in a range of other health conditions, including blood cancer (leukemia), a blood condition that leads to fatigue (anemia), a condition due to high blood pressure that affects the eyes (hypertensive retinopathy), a pregnancy complication characterized by high blood pressure (pre-eclampsia), a diabetes-related eye condition (diabetic retinopathy), and a condition connected with low oxygen levels (anoxia).
What Causes Roth Spots?
In the past, we believed that Roth spots (unique mark on the retina) were a certain sign of an infection of the heart lining and valves due to trapped bacteria in the retina. However, new studies suggest that Roth spots actually come from a broken blood vessel in the retina, causing a bleed inside the retina. These Roth spots can show up in many different diseases where the blood vessels in the retina are damaged, causing bleeding.
These conditions have one thing in common: they have a higher risk for blood vessel problems. This leads to disruption in the tiny blood vessels in your retina. When we look at these spots under a microscope, the white parts of the spots are mainly made up of a protein called fibrin. This fibrin forms a plug with platelets (a type of blood cell) at the site where the blood vessel has broken.
Risk Factors and Frequency for Roth Spots
White centered retinal hemorrhages, also known as Roth spots, are seen in the eyes due to various health conditions. They can be detected during an eye examination, often found in the peripheral or back of the eyes. A common factor in all causes is the dysfunction of the retinal endothelium, the thin layer of cells that lines the interior surface of blood vessels in the eye. There are many conditions that can cause Roth spots, including:
- Bacterial endocarditis, an infection within the heart.
- Anemia or thrombocytopenia, conditions that affect the blood’s composition.
- Collagen vascular disease, a group of diseases that affect your connective tissues.
- Leukemia, a type of cancer that affects the blood and bone marrow.
- Hypertensive retinopathy, a condition caused by high blood pressure.
- Diabetic retinopathy, eye damage that can occur with diabetes.
- Pre-eclampsia, a pregnancy complication usually related to high blood pressure.
- Human Immunodeficiency Virus (HIV), the virus that causes AIDS.
- Anoxia, a condition in which the body or a region of the body is deprived of oxygen.
- Shaken baby syndrome, a severe form of child abuse resulting from violently shaking an infant.
Signs and Symptoms of Roth Spots
Roth spots are a type of retinal hemorrhage seen in the eyes, often indicating an underlying health problem. These spots can be found during a routine eye examination, even before any symptoms appear. However, they are also discovered when patients have general symptoms of illness. Consequently, finding Roth spots should alert the doctor to check for possible underlying diseases by taking a detailed patient history and thorough physical examination.
A comprehensive patient history can guide the doctor towards identifying the underlying cause. This history should include any symptoms associated with common causes of Roth spots such as endocarditis (a type of heart infection) or a blood disorder. Such symptoms may include:
- fever
- chills
- night sweats
- unexplained weight loss
- fatigue
- abnormal bleeding or bruising
- shortness of breath
Details about the patient’s prior medical history and family history may also help to pinpoint the cause.
When Roth spots are seen during an eye examination, the doctor should also look for other abnormalities in the retina. It’s important to monitor the patient’s vital signs like blood pressure, temperature, and pulse rate. Particular physical examination findings are associated with various causes of these white-centered retinal hemorrhages. Therefore, doctors need to stay alert during the exam. For instance, when there are Roth spots and susceptibility to endocarditis, the doctor must thoroughly check for other signs of this heart infection which may include:
- Janeway lesions
- Osler nodes
- splinter hemorrhages
- petechiae
- heart murmurs
Other observations like digitally enlarged fingertips (clubbing), enlarged spleen, and abnormalities in breathing may also provide useful information.
Testing for Roth Spots
The first step in evaluating a patient’s condition involves gathering detailed information about their medical history and conducting a thorough physical examination. Key to this process is completing a complete blood count test to check for abnormalities – this may show increase or decrease in white blood cells pointing towards infection, low red blood cell count suggesting anemia, or low blood platelet count indicating thrombocytopenia, among other potential blood-related issues.
Additionally, doctors usually check for diabetes by measuring fasting plasma glucose or hemoglobin A1C levels. If an infection is suspected, your healthcare provider may need to further assess with tests like erythrocyte sedimentation rate, C-reactive protein and blood cultures which assist in measuring the level of inflammation in the body and identifying any foreign agents in your blood.
An echocardiogram, which is a type of ultrasound that allows doctors to see the heart and its function in real-time, may be ordered if there’s suspicion of endocarditis, an infection of the inner lining of the heart. There could also be other specific tests like HIV antibody testing, certain imaging studies or a peripheral blood smear (a test that examines the individual cells in your blood) based on your symptoms and the doctor’s findings during the physical examination.
Treatment Options for Roth Spots
Roth spots are usually not accompanied by symptoms and are often discovered during a regular eye check-up that involves dilation of the eyes. It’s rare, but possible, for Roth spots to cause vision disturbances, especially if they are located in the part of the eye responsible for fine details (the macula). The good news is that most of these white-centered retinal hemorrhages, or Roth spots, generally get better on their own.
However, it’s essential to remember that Roth spots are often a sign of an underlying condition. This is why, once discovered, it’s necessary to diagnose and treat the root cause of Roth spots to avoid further complications, both within and beyond the eyes.
After the Roth spots are found, especially during an acute or sudden illness, follow-up visits with an eye doctor or ophthalmologist are crucial to ensure that the condition doesn’t worsen over time.
What else can Roth Spots be?
There are several conditions that can result in similar symptoms which may need to be considered for accurate diagnosis including:
- Anemia (low iron in the blood)
- Anoxia (absence of oxygen)
- Carbon Monoxide poisoning
- Complicated Labor (difficulties during childbirth)
- Diabetic Retinopathy (damage to the eyes caused by diabetes)
- HIV Retinopathy (eye issues caused by HIV)
- Hypertension (high blood pressure)
- Intracranial Hemorrhage (bleeding within the skull)
- Preeclampsia (high blood pressure during pregnancy)
- Shaken Baby Syndrome (brain injury from forcefully shaking a baby)
- Subacute Bacterial Endocarditis (infection on the heart valves)
