Roth Spots in Eye: what Do They Mean?

What do they look like?

Roth spots appear on your retina as areas of blood with pale or white centers. The white spot is made of fibrin, a protein that works to stop bleeding. These spots can come and go, sometimes appearing and disappearing in a matter of hours.

What’s their relationship to endocarditis?

For a long time, doctors thought that Roth spots were a sign of endocarditis. Endocarditis is an infection of the heart’s lining, called the endocardium. It can also affect the valves and muscle of the heart.

Endocarditis is usually caused by bacteria that enter the bloodstream through the mouth or gums. Doctors used to think that the white area seen in Roth spots was a septic embolism. This refers to a blockage — usually a blood clot — that’s infected. The white center, they thought, was pus from the infection. However, they now know that the spot is made of fibrin.

Roth spots can be a symptom of endocarditis, but only 2 percent of people with endocarditis have them.

What else causes them?

Roth spots are caused by conditions that make blood vessels fragile and inflamed. In addition to endocarditis, these conditions include:

  • diabetes
  • leukemia
  • high blood pressure
  • preeclampsia
  • anemia
  • Behcet’s disease
    • HIV

How are they diagnosed?

Roth spots are diagnosed during an eye exam. Your doctor will start by dilating your pupils with eye drops before looking at your eye using one of two methods:

  • Funduscopy. Your doctor will use a lighted scope with attached lenses, called an ophthalmoscope, to look at the fundus of your eye. The fundus includes the retina and blood vessels.
  • Slit lamp exam. A slit lamp is a magnifying instrument with a very bright light that gives your doctor a better view of the inside of your eye.

While these tests don’t come with many risks, the drops used to dilate your pupils might sting or cause blurry vision for a few hours.

Based on what they find during the exam, your doctor might order blood and urine tests to see what might be causing them. They may also use an echocardiogram to get a view of your heart and check for signs of endocarditis or other damage.

How are they treated?

There’s no specific treatment for Roth spots, since a variety of conditions can cause them. However, once the underlying condition is treated, Roth spots usually go away on their own.

Living with Roth spots

While Roth spots used to be associated with just a dangerous heart infection, they can result from many things, including diabetes and anemia. If your doctor finds them during an eye exam, they’ll likely order some additional tests to check for any underlying conditions that might be causing them.

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