Multiple evanescent white dot syndrome

Multiple evanescent white dot syndrome (MEWDS) is an uncommon inflammatory condition of the retina that typically affects otherwise healthy young females in the second to fourth decades of life.

The typical patient with MEWDS is a healthy middle aged female age 15-50. There is a gender disparity as women are affected with MEWDS four times more often than men. Roughly 30% of patients have experienced an associated viral prodrome. Patients present with acute, painless, unilateral change in vision. [1]

Presentation

Patients commonly present with acute unilateral painless decreased vision and photopsias.[2] Presentations like central or paracentral scotoma, Floaters and dyschromatopsia are less common.[2] An antecedent viral prodrome occurs in approximately one-third of cases. Myopia is commonly seen in patients.

Eye exam during the acute phase of the disease reveals multiple discrete white to orange spots at the level of the RPE or deep retina, typically in a perifoveal location (around the fovea). Optic disc oedema may also seen occasionally.[2]

Cause

The etiology of multiple evanescent white dot syndrome is currently unknown. However, it is associated with the Pfizer vaccine according to the Jerusalem Post, August 4, 2021.[2]

Diagnosis
  • Visual field abnormalities are variable and include generalized depression of visual field, paracentral or peripheral scotoma and enlargement of the blind spot.
  • Fluorescein angiography of the eye reveals characteristic punctate hyperfluorescent lesions in a wreath-like configuration surrounding the fovea.
  • Indocyanine green angiography reveals hypofluorescent lesions in a greater number compared with other studies.
  • Fundus autofluorescence (FAF) has been shown to be a noninvasive method to demonstrate the subretinal spots in MEWDS.

Treatment

MEWDS is a self limited disease with excellent visual recovery within 2-10 weeks. However residual symptoms including photopsia may persist for months.

References
  1. Brian Toussaint MD (December 6, 2014). [Multiple_Evanescent_White_Dot_Syndrome "Multiple Evanescent White Dot Syndrome"]. EyeWiki. {{cite web}}: Check |url= value (help)
  2. John F, Salmon (13 December 2019). "Uveitis". Kanski's clinical ophthalmology : a systematic approach (9th ed.). Elsevier. p. 484. ISBN 978-0-7020-7711-1.
  3. Basic and Clinical Science Course; Intraocular inflammation and uveitis (2011-2012 ed.). American Academy of Ophthalmology. 2012. ISBN 978-1615251162.
  4. Basic and Clinical Science Course; Retina and vitreous (2011-2012 ed.). American Academy of Ophthalmology. 2012. ISBN 978-1615251193.
  5. Myron, Yanoff (2008). Ophthalmology (3rd ed.). Mosby. ISBN 978-0323057516.
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