Roth Spots are multiple flame-shaped or round, oval shape retinal hemorrhages with white centered spots. There are many causes of them but in 80% of cases they are associated bacteremia that is caused by subacute bacterial infective endocarditis.
Roth spot represents rupture of retinal capillaries with leakage of blood and the central white spot are caused by platelet aggregates, fibrin thrombus and infiltrating red blood cells. In the past, they thought that these white spots represent embolic foci of the abscesses caused by bacteria originating from infective heart valves.
Roth Spots Causes
Most of these diseases cause damage to the underlying retinal blood vessels.
1- Infective endocarditis which can be caused by valvular disease, structural heart disease, prosthetic valves, dental infection and IV drug use.
2- Hypertension, eclampsia and pre-eclampsia.
4- Leukemia and lymphoma.
6- Bechet Disease
7- Carbon monoxide poisoning
Symptoms of Roth Spots
Roth spots are usually asymptomatic unless they involve the macula or the area responsible for central vision or if they associated with other retinal such as diabetic retinopathy.
Diagnosis of Roth Spots
1- Retinal examination by an eye doctor. Roth spots appear as flame-shaped hemorrhage with which central spots.
2- Systemic review and examination in the suspicion of systemic diseases.
3- Laboratory tests for the underlying diseases such as CBC with differential, hba1c level, C-reactive protein, HIV blood tests, erythrocyte sedimentation rate, and blood cultures should be drawn especially in the suspicion of endocarditis. Sometimes, transthoracic echocardiogram should be obtained in the presence of other systemic symptoms of endocarditis.
Treatment of Roth Spots
Roth spots are usually asymptomatic and there is no specific treatment for them but treatment of the underlying disease usually resolve them.
Ocular manifestation of Infective endocarditis
1- Roth spots.
2- Subconjunctival Hemorrhage.
3- Retinal vein occlusion such as central retinal vein and branch retinal vein occlusions
4- Central Retinal artery occlusions
5- Retinal and vitreal infiltration which are caused by infected embolism that travels from the heart to the eye and cause vitritis, choroiditis, chorioretinitis and retinitis.
6- Ophthalmic arterial occlusion which can cause sudden complete loss of vision or blindness plus paralysis of ocular muscles and movements.
7- Endogenous bacterial endophthalmitis.