Atlas Entry - Multiple evanescent white dot syndrome (MEWDS)

Multiple evanescent white dot syndrome (MEWDS)

Category(ies): Retina, Uveitis

Contributor: Jesse Vislisel, MD; Karen Gehrs, MD

Photographer: Carol Chan, CRA

Figure 1

Multiple evanescent white dot syndrome (MEWDS) results from idiopathic inflammation of the retina. It is most common in healthy, young, white, myopic females and typically has an acute and unilateral presentation.

Multiple evanescent white dot syndrome (MEWDS) fundus — As seen in the photograph, the condition causes multiple, discrete, gray-white spots in the outer retina or retinal pigmented epithelium (RPE). There are pathognomonic granular changes within the fovea. Mild intraocular inflammation may be present.

Enlarge Download

Multiple evanescent white dot syndrome (MEWDS) Fundus fluorescein angiography (FFA) — Fundus fluorescein angiography (FFA) shows early punctate hyperfluorescence

Enlarge Download

Multiple evanescent white dot syndrome (MEWDS) Fundus fluorescein angiography (FFA) late — Fundus fluorescein angiography (FFA) shows late staining of the lesions arranged in a "wreath-like" configuration around the fovea.

Enlarge Download

Figure 2

Contributor: Jeffrey Welder, MD

Photographer: : Brice Critser, CRA

Enlarge Download

Multiple evanescent white dot syndrome (MEWDS) fundus normal — Fundus, right (normal)

Enlarge Download

Multiple evanescent white dot syndrome (MEWDS) fundus abnormal with white spots — Fundus, eft (abnormal)

Enlarge Download

Multiple evanescent white dot syndrome (MEWDS) fundus FA — Fluorescein angiography showed classic punctate hyperfluorescence in a wreath-like pattern in the left eye

Enlarge Download

Figure 3

Contributor: Luke Lenci, MD

Photographer: : Brice Critser, CRA

This case represents the more severe end of the spectrum for MEWDS. This young, myopic female presented with a complaint of unilateral shimmering photopsias and a paracentral scotoma. Her exam showed the pathognomic subfoveal yellow/orange granularity in the right eye along with an FFA that had a classic "wreathlike" hyperfluorescence. Disc edema is also seen in the right eye.