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Understanding Multiple Evanescent White Dot Syndrome (MEWDS) - Case Study

Explore a comprehensive case study on a patient with MEWDS, including initial presentation, diagnosis, follow-up, and discussion of this inflammatory choriocapillaropathy. Learn about clinical findings, imaging results, and the natural course of this condition.

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Understanding Multiple Evanescent White Dot Syndrome (MEWDS) - Case Study

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  1. Multiple Evanescent White Dot Syndrome (MEWDS) Dr. PadmamaliniMahendradas Dr. KavithaAvadhani Department of Uveitis & Ocular Immunology NarayanaNethralaya, Bangalore

  2. Ocular and General History • 42 year old Asian Indian • Complaints of sudden blurring of vision associated with flashes in her left eye for the past 4 days. • No other systemic illness or preceding flu

  3. At PresentationOcular Examination • Visual acuity 1.0, N6 in both eyes • IOP was within normal limits in OU • OD: Normal • OS: Anterior segment was quiet

  4. First Presentation - Fundus Examination • Yellowish white dots in the deep retina in both the posterior pole and up to the mid periphery in the left eye and • foveal granularity

  5. First Presentation – FFA and Autofluorescence • Fluorescein angiography: stippled hyperfluorescence corresponding to the yellow white lesions • Autofluorescence: many more lesions than seen clinically as hyperfluorescent areas.

  6. First presentation – Visual Fields • Enlarged blind spot

  7. First presentation - OCT • Spectral Domain OCT through the lesions shows a disruption in the IS/OS junction with focal hyper reflectivity and vitreous cells indicates that the photoreceptor layer is involved and corroborates well with electrophysiology findings seen in MEWDS suggesting that MEWDS occurs in the outer retina and/or retinal pigment epithelium

  8. Diagnosis OS: Multiple Evanescent White Dot Syndrome (MEWDS)

  9. Follow up – 5 Weeks • Five weeks after the initial presentation nearly all lesions seen clinically had disappeared • Visual field showed disappearance of the scotoma

  10. Follow-up OCT – after 5 weeks • OCT reveals disappearance of posterior vitreous cells • Disappearance of posterior vitreous cells and restoration of outer retinal layers

  11. Discussion • MEWDS is an inflammatory choriocapillaropathy of unknown origin first described in 1984 by Jampol et al.* • It affects young females and a flu like illness may precede the disease. • Patients of MEWDS typically present with complaints of decreased vision and scotoma. • Spontaneous recovery without any treatment in 1 to 2months *Jampol LM et al:Multiple evanescent white dot syndrome. Arch Ophthalmol 1984;102:671-4.

  12. THANK YOU

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