Roth Spots

What are Roth spots?

Roth spots are small areas of bleeding (hemorrhages) that can happen on the retinas inside your eyes. They usually don’t cause any changes you can see or feel, but they’re often a major indicator of health conditions.

Roth spots also aren’t visible to casual observers. The only way someone else can see them is to look inside your eye using a tool like a slit lamp or ophthalmoscope.

In uncommon cases, Roth spots can affect your eyesight under the right circumstances. The most likely way this can happen is if they affect the macula, the part of your retina responsible for the center of your visual field.

What do Roth spots look like?

Your retina is a light-sensitive layer of cells that covers the fundus, the inside back surface of your eye. Viewed with a slit lamp or ophthalmoscope, a healthy retina looks somewhat orange (though it can lean lighter toward yellowish-orange or darker toward reddish-orange). Also on that surface is a spiderweb-like pattern of blood vessels.

Roth spots stand out because they’re darker — usually a deep orange, maroon or red — and they have a white or pale-colored pinpoint center. The darker patch is from blood that leaked out of a nearby blood vessel. The pale pinpoint dot at the center was the exact site of the retinal bleeding (retinal hemorrhage). It’s white or pale because your body’s natural clotting (hemostasis) process plugged the bleeding and started repairs.

What are the most common causes of Roth Spots?

Researchers in the late 1800s initially linked Roth spots to infective endocarditis. That’s when an infection attacks the inside of your heart (usually the valves, but occasionally other internal parts). Most cases where this happens are “subacute,” meaning they aren’t yet causing symptoms severe enough for a person to get medical attention.

The infections can be from bacteria or viruses, and sometimes even from parasites or fungi. If the infection causes infected blood clots to form, those clots can leave your heart and travel anywhere in your body.

The blood vessels in your retinas are tiny, making it easy for a clot to wedge inside and rupture the vessel. That causes bleeding that will later turn into a Roth spot. Those clots can also spread an infection to the inside of your eye and cause endophthalmitis.

But ongoing research shows infective endocarditis only accounts for about 5% of cases involving Roth spots. That research also shows that Roth spots can happen with a huge range of conditions.

Other conditions that can cause Roth spots

Some of the other most common conditions that can cause Roth spots include:

• Blood disorders like anemia and thrombocytopenia.
• Cancers like leukemia and multiple myeloma.
• Connective tissue disorders and autoimmune diseases like ankylosing spondylitis, lupus (systemic lupus erythematosus), and Behçet’s disease.
• Heart and circulatory conditions like high blood pressure (hypertension).
• Infections like toxoplasmosis, leishmaniasis and HIV, or even from abscessed teeth.
• Metabolic conditions like Type 2 diabetes.
• Pregnancy complications like preeclampsia and eclampsia.
• Severe lack of oxygen (anoxia), including carbon monoxide poisoning.
• Spending time at high altitudes, usually over 12,000 feet (3,650 meters). It can sometimes happen at lower altitudes if you’re dehydrated or have other conditions that affect your blood oxygen level or circulation.
• Injuries, especially concussions and traumatic brain injuries (TBIs), eye injuries and shaken baby syndrome.

How are Roth spots treated?

There’s no way to treat Roth spots directly. Instead, the treatments focus on the underlying cause. Roth spots usually get better if you can resolve or manage whatever’s causing them.

The treatments that can help Roth spot-causing conditions can vary widely. Your eye care specialist or healthcare provider is the best person to recommend treatment options and give you more information.

What are the possible complications or risks of not treating it?

Roth spots are usually just an indication of another condition. In uncommon cases, they may temporarily disrupt your vision, but that usually goes away with treatment of the underlying cause.

But the conditions that cause Roth spots can often be very severe, and a few are dangerous. If an eye care specialist finds one during an eye exam, they’ll refer you to another provider, usually a primary care provider (if you don’t already have one). That provider will work to find the underlying cause and either treat it or refer you to another specialist for further testing and treatment.