**5. Ocular clinical findings**

#### **5.1. Roth dots**

A Roth dot is a cluster of superficial retinal hemorrhages ovally shaped, with pale center (**Figure 1**). It is commonly seen near the optic disk.

In endocarditis, this cluster represents red blood cells which surround inflammatory cells that have collected in the area in response to a septic embolism from valvular vegetations [1].

#### **5.2. Retinal arterial occlusion**

Retinal arterial occlusion occurs as a complication of septic or aseptic embolism. Clinical manifestations depend on the localization of occlusion. We distinguish the following.

#### *5.2.1. Central retinal arterial occlusion*

Patient, if conscious, presents sudden, complete, and painless loss of vision in one eye. Fundoscopy shows pale edema of the retina, particularly in the posterior pole where the nerve fiber and ganglion cell layers are thickest. The orange reflex of the foveola with intact choroidal vasculature contrasts with the surrounding opaque neural retina, producing the cherry red spot. Central retinal arterial occlusion (CRAO) has a poor prognosis. If not treated in the first hour, it can lead to permanent loss of vision and other ocular complications [6].

**Figure 1.** Fundoscopy of the left eye showing multiple Roth dots.
