Roth's spot

Roth's spots, also known as Litten spots or the Litten sign,[1] are non-specific red spots with white or pale centres, seen on the retina and although traditionally associated with infective endocarditis, can occur in a number of other conditions including hypertension, diabetes, Collagen vascular disease, extreme hypoxia, leukemia and HIV.[2][3]

Roth's spot
Other namesLitten sign
CausesConditions that predispose to endothelial damage of retinal capillaries
Diagnostic methodFundoscopy

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 eye) or slit lamp exam.[2][3]

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 coagulated fibrin including platelets, focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells.[4]


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.[2]

Associated conditions

Conditions associated with Roth's spots include:[2][1]

and also:[3]


Roth's spots occur in only 5% of people with infective endocarditis.[5] Litten, however reported a figure of 80%.[2]

See also


  1. "What is a roth spot?". Stanford Medicine 25. 24 March 2016. Retrieved 11 August 2019.
  2. Ruddy, Stephanie M.; Bergstrom, Reece; Tivakaran, Vijai S. (2019), "Roth Spots", StatPearls, StatPearls Publishing, PMID 29494053, retrieved 11 August 2019
  3. Blumenthal, Eytan Z.; Ehud, Zamir (9 March 1999). "Roth's Spots". Circulation. 99 (9): 1271. doi:10.1161/01.CIR.99.9.1271. PMID 10069798.
  4. Lepore, Frederick (1995). "Roth's Spots in Leukemic Retinopathy". New England Journal of Medicine. 332 (5): 335. doi:10.1056/NEJM199502023320515. PMID 7816078.
  5. "What are the classic signs of infective endocarditis (IE)?". Retrieved 12 August 2019.

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