Roth Spot

  • Cotton wool spot surrounded by hemorrhage, representing retinal microinfarct that bled
  • Not specific for endocarditis
  • Many conditions cause this, including hypertension, diabetes, blood dyscrasia, HIV, bacterial endocarditis, connective tissue diseases, abusive head trauma in infants
  • Interpret this as sign of small vessel occlusive disease of many causes
  • Refer non-urgently to ophthalmologist for confirmation
  • Roth spots do not usually affect vision, but they reflect systemic illness, including bacterial endocarditis, that could have dire consequences if not treated