View source for Roth's spot

{{short description|Red lesion on the retina of the eye}}
{{Infobox medical condition
 |name          = Roth's spot
 |synonym       = Litten sign
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 |specialty     = [[Ophthalmology]]
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 |causes        = Conditions that predispose to endothelial damage of retinal capillaries
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 |diagnosis     = [[Fundoscopy]]
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'''Roth's spots''', also known as '''Litten spots''' or the '''Litten sign''',<ref name=Stanford2016/> are non-specific red [[lesion]]s with white or pale centres, seen on the [[retina]] of the eye and although traditionally associated with [[infective endocarditis]], can occur in a number of other conditions including [[hypertension]], [[diabetes|diabetes mellitus]], [[collagen vascular disease]], [[Hypoxia (medical)|extreme hypoxia]], [[leukemia]] and [[HIV]].<ref name=Ruddy2019>{{Citation|last1=Ruddy|first1=Stephanie M.|title=Roth Spots|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK482446/|work=StatPearls|publisher=StatPearls Publishing|pmid=29494053|access-date=11 August 2019|last2=Bergstrom|first2=Reece|last3=Tivakaran|first3=Vijai S.}}</ref><ref name=Blumenthal1999>{{Cite journal|last1=Blumenthal|first1=Eytan Z.|last2=Ehud|first2=Zamir|date=9 March 1999|title=Roth's Spots|journal=Circulation|volume=99|issue=9|pages=1271|doi=10.1161/01.CIR.99.9.1271|pmid=10069798|doi-access=free}}</ref>

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]]. They are typically observed via [[fundoscopy]] (using an [[ophthalmoscope]] to view inside the [[human eye|eye]]) or slit lamp exam.<ref name=Ruddy2019/><ref name=Blumenthal1999/>

The original retinal spots identified in 1872 were attributed to nerve-fibres that had burst. Present-day analysis shows that they can be composed of [[coagulate]]d [[fibrin]] including [[platelets]], focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells.<ref name="NEJM">{{cite journal|last1=Lepore|first1=Frederick|year=1995|title=Roth's Spots in Leukemic Retinopathy|journal=New England Journal of Medicine|volume=332|issue=5|pages=335|doi=10.1056/NEJM199502023320515|pmid=7816078|doi-access=free}}</ref>

==Cause==
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. Looking through the microscope reveals lesions with white centers made mainly of [[fibrin]], depicting a fibrin-platelet plug at the site of vessel damage.<ref name=Ruddy2019/>

==Associated conditions==
Conditions associated with Roth's spots include:<ref name=Ruddy2019/><ref name=Stanford2016>{{Cite web|url=https://stanfordmedicine25.stanford.edu/blog/archive/2016/Fevers-mild-confusion-and-this-retinal-finding-Diagnosis.html|title=What is a roth spot?|date=24 March 2016|website=Stanford Medicine 25|language=en|access-date=11 August 2019}}</ref>''
* [[Infective endocarditis]]
* [[Anaemia]]/[[thrombocytopenia]]
* [[Collagen vascular disease]]
* [[Leukemia]]
* [[Hypertensive retinopathy]]
* [[Diabetic retinopathy]]
* [[Pre-eclampsia]]
* [[Human Immunodeficiency Virus]] (HIV)
* [[Hypoxia (medical)|Extreme hypoxia]]
* [[Abusive head trauma|Shaken-baby syndrome]]
and also:<ref name=Blumenthal1999/>
* [[Candida albicans]] infection
* [[vascular disease]]s
* [[kala azar]]

==Prevalence==
Roth's spots occur in only 5% of people with infective endocarditis.<ref name="Medscape">{{Cite web|url=https://www.medscape.com/answers/216650-30468/what-are-the-classic-signs-of-infective-endocarditis-ie|title=What are the classic signs of infective endocarditis (IE)?|website=www.medscape.com|access-date=12 August 2019}}</ref> Litten, however reported a figure of 80%.<ref name=Ruddy2019/>

==See also==
* [[Osler's nodes]]
* [[Janeway lesion]]
* [[Splinter haemorrhage]]

==References==
{{reflist}}

==External links==
* [http://www.nejm.org/doi/full/10.1056/NEJMicm1312093 Image from the New England Journal of Medicine: Endocarditis]
* [http://www.nejm.org/doi/full/10.1056/NEJMicm040783 Image from the New England Journal of Medicine: CML]

{{Eponymous medical signs for eyes and ears}}
{{Cardiovascular system symptoms and signs}}

[[Category:Eye diseases]]
[[Category:Symptoms and signs: Cardiac]]


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