From the Research
Roth spots are distinctive retinal lesions characterized by a white or pale center surrounded by hemorrhage, resembling a "white-centered hemorrhage," and their presence should prompt further investigation for underlying systemic conditions, as seen in a recent case of Essential Thrombocythemia 1.
Definition and Characteristics
Roth spots are typically round or oval-shaped spots on the retina, appearing during an eye examination. They are most commonly associated with various conditions, including:
- Infective endocarditis
- Leukemia
- Anemia
- Diabetes
- Hypertension
- Vasculitic disorders The white center of a Roth spot represents either a fibrin-platelet thrombus, an accumulation of white blood cells, or an area of ischemic retina, while the surrounding hemorrhage occurs when blood leaks from the damaged vessel.
Clinical Significance
Although Roth spots are not specific enough to diagnose any particular condition on their own, their presence should prompt further investigation, particularly for infective endocarditis in the appropriate clinical context, as well as other conditions such as Essential Thrombocythemia 1. An ophthalmologist can identify these lesions during a dilated fundoscopic examination, which is important for patients with suspected endocarditis or unexplained fever. Additionally, Roth spots may be associated with other conditions, such as ocular toxoplasmosis 2 and neoplastic angioendotheliosis 3.
Diagnosis and Management
A comprehensive workup, including a thorough medical history, physical examination, and laboratory tests, is essential to determine the underlying cause of Roth spots. In some cases, further testing, such as imaging studies or biopsies, may be necessary to confirm the diagnosis. Treatment of the underlying condition is crucial to prevent further complications and improve patient outcomes. For example, in the case of Essential Thrombocythemia, treatment with low-dose oral aspirin may be effective in resolving symptoms and fundus findings 1.