Manchas de Roth
Roth spots, also called manchas de Roth, are small retinal findings that can point to important health conditions. Moritz Roth first described these spots in the 19th century, and Moritz Litten later studied them. These spots appear as red areas with pale or white centers on the retina. They do not represent a disease themselves but signal an underlying condition that may need attention.
People often do not notice these spots because they usually do not cause vision problems. Their presence can be linked to issues such as high blood pressure, diabetes, leukemia, HIV, or bacterial endocarditis. Trauma or blood disorders can also cause them, so doctors consider them a valuable clue when evaluating overall health.
Definition of Symptom
Roth’s spots are white-centered retinal hemorrhages found on the retina during an eye exam. They look like red areas with a pale or white center. These spots form when small blood vessels in the retina break and bleed, leaving behind a clot or collection of cells.
The white center often contains fibrin, platelets, or damaged tissue. Most people with Roth spots do not notice changes in vision. Eye doctors usually find them during routine exams. If the macula is involved, mild blurring or distortion of central vision can happen.
Key Features of Roth’s Spots
- Location: Retina.
- Appearance: Red hemorrhage with a white or pale center.
- Symptom Impact: Usually none; rare vision changes if macula is affected.
The white center makes these spots distinct from other retinal hemorrhages. Doctors see Roth spots as a sign of an underlying condition rather than a disease itself. Roth spots can appear before other symptoms of systemic illness, making them a useful clinical clue during eye exams.
Possible Causes/Diseases Condition
Roth spots often show up as a sign of an underlying illness rather than an isolated eye problem. Damage to the retinal blood vessels causes small hemorrhages with a pale center.
- Infective endocarditis, especially subacute bacterial endocarditis, stands out as a well-known cause. These spots can serve as an early clue to this heart infection.
- Diabetes and diabetic retinopathy are also common associations. High blood sugar over time can weaken blood vessels in the retina, making them prone to bleeding.
- Anemia and thrombocytopenia contribute by reducing the blood’s ability to carry oxygen or clot. Both conditions increase the risk of retinal hemorrhages.
- Hypertension can damage small vessels in the eye, while preeclampsia in pregnancy may trigger similar changes.
- Leukemia is another important cause. Abnormal blood cells and clotting problems in leukemia can lead to retinal bleeding and Roth spots.
Other less common links include HIV, collagen vascular diseases such as lupus, and trauma-related conditions like shaken baby syndrome. The table below highlights some key associations:
| Condition | Possible Mechanism |
|---|---|
| Infective Endocarditis | Infection-induced damage to the retinal blood vessels. |
| Diabetes/Diabetic Retinopathy | Microvascular injury. |
| Anemia/Thrombocytopenia | Reduced oxygen or clotting. |
| Hypertension | Vascular stress and rupture. |
| Leukemia | Abnormal blood cells and bleeding. |
| Preeclampsia | Vascular dysfunction in pregnancy. |
| HIV/Collagen Vascular Disease | Immune or vessel injury. |
| Shaken Baby Syndrome | Retinal trauma. |
Other Non-Disease Causes
Not all Roth spots come from chronic illness. Physical stress or injury that affects the blood vessels in the retina can also cause them. These situations are often temporary but still require careful evaluation.
- Anoxia (lack of oxygen) can damage the retina and cause Roth spots. Severe blood loss, shock, or respiratory failure may trigger this condition.
- Carbon monoxide poisoning can also cause Roth spots. Reduced oxygen delivery to tissues harms the retina, and these spots may appear as part of the damage.
In infants, complicated labor or birth trauma can lead to Roth spots. Pressure changes and reduced oxygen during delivery can cause small retinal hemorrhages with white centers. Intracranial hemorrhage can also be linked to Roth spots. Increased pressure inside the skull may affect retinal circulation, leading to these findings. A quick reference table summarizes these causes:
| Non-Disease Cause | Possible Mechanism | Common Contexts |
|---|---|---|
| Anoxia | Oxygen deprivation damages retina | Shock, severe blood loss |
| Carbon Monoxide | Reduced oxygen transport | Poisoning, smoke inhalation |
| Complicated Labor | Birth trauma and hypoxia | Newborns, difficult delivery |
| Intracranial Hemorrhage | Increased intracranial pressure | Head injury, brain bleed |
These causes show that Roth spots can result from acute, non-disease events.
How It Causes the Symptom
When small retinal blood vessels break and leak blood, Roth spots form. A white center appears due to deposits of fibrin, platelets, or inflammatory cells. This mix creates the classic red spot with a pale core seen during an eye exam.
These spots rarely cause vision problems. Symptoms occur only if the macula, the part of the retina responsible for sharp vision, is involved. In most cases, the spots mark an underlying cause rather than being the main source of discomfort.
Doctors investigate systemic illness when they find Roth spots. They may order blood tests to check for inflammation or infection, or look for abnormal blood cells linked to leukemia or anemia.
If infection is suspected, doctors may order blood cultures to look for bacteria in the bloodstream. An echocardiogram can help detect heart valve infections, and HIV testing may be done if immune suppression is a concern. Doctors may also check blood sugar for diabetes and use imaging tests to look for organ damage.
Possible Complications
Roth spots themselves usually do not cause vision loss, but they can signal serious illness. If left unchecked, the underlying condition may lead to complications that affect both the eyes and other organs.
Cardiac problems can develop when Roth spots are linked to infective endocarditis. People may develop Janeway lesions, Osler nodes, or splinter hemorrhages, which show vascular injury. These findings can come with shortness of breath or even clubbing of the fingers in chronic cases. People may experience fatigue, night sweats, or weight loss, which often suggest a prolonged infection or chronic disease process.
Bleeding issues can happen when Roth spots are tied to blood disorders. People may notice petechiae, abnormal bleeding, or easy bruising. These complications raise concern for platelet or clotting problems that require further testing. The table below highlights some related findings:
| Complication Type | Examples | Possible Association |
|---|---|---|
| Vascular lesions | Janeway lesions, Osler nodes, splinter hemorrhages | Infective endocarditis |
| Systemic symptoms | Fatigue, weight loss, night sweats | Chronic infection or inflammation |
| Hematologic signs | Petechiae, bruising, abnormal bleeding | Blood disorders |
| Respiratory signs | Shortness of breath, clubbing | Cardiac or pulmonary disease |
When to Seek Medical Attention
Roth spots often appear without causing vision problems. Because they can signal underlying health issues, an eye examination is important if you notice them. See an ophthalmologist promptly if you notice:
- Sudden changes in vision.
- Blurred or distorted sight.
- New floaters or dark spots.
- Eye pain or discomfort.
If a doctor finds Roth spots during a routine exam, they may suggest further tests. These spots can indicate conditions such as diabetes, anemia, or heart infections. Seek urgent care if Roth spots come with:
- Fever or chills
- Shortness of breath
- Chest pain
- Unexplained fatigue
Doctors may suggest blood tests, heart checks, or other scans to find the cause. Treating the underlying illness often helps the eye changes improve. Regular visits to an ophthalmologist and a primary care doctor can help spot Roth spots early and guide treatment.
