Roth spots | |
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Other names: Litten sign | |
Roth spot on the retina of the left eye in infective endocarditis | |
Specialty | Ophthalmology, cardiology, general medicine |
Symptoms | Red spots with white or pale centres[1] |
Causes | Conditions that predispose to endothelial damage of retinal capillaries[1] |
Diagnostic method | Fundoscopy, visual appearance[1] |
Frequency | 80% of people with subacute bacterial endocarditis[1] |
Roth spots, also known as Litten spots are non-specific red spots with white or pale centres, seen on the retina.[1] Although traditionally associated with infective endocarditis, they can occur in a number of other conditions including hypertension, diabetes, collagen vascular disease, extreme hypoxia, leukemia and HIV.[2]
The spots are typically observed via fundoscopy (using an ophthalmoscope to view inside the eye) or slit lamp exam.[1][2] They can be composed of coagulated fibrin including platelets, focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells.[3]
Around 80% of people with subacute bacterial endocarditis have Roth spots.[1] Red and white retinal spots were first observed in 1872 by Swiss physician Moritz Roth, and named "Roth spots" six years later by Moritz Litten.[4]
Roth's spots occur in conditions that predispose to endothelial damage of retinal capillaries, that is when there is dysfunction and disruption of the endothelium of retinal capillaries.[1] Looking through the microscope reveals lesions with white centers made mainly of fibrin, depicting a fibrin-platelet plug at the site of vessel damage.[1]
Conditions associated with Roth's spots include:[1][5]
and also:[2]
Roth's spots occur in only 5% of people with infective endocarditis.[6] Litten, however reported a figure of 80%.[1]