Multiple evanescent white dot syndrome (MEWDS) is an uncommon inflammatory condition of the

retina The retina (from la, rete "net") is the innermost, light-sensitive layer of tissue of the eye of most vertebrates and some molluscs. The optics of the eye create a focused two-dimensional image of the visual world on the retina, which then ...

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.

Presentation

Patients commonly present with acute unilateral painless decreased vision and

photopsias Photopsia is the presence of perceived flashes of light in the field of vision. It is most commonly associated with: * posterior vitreous detachment * migraine aura ( ocular migraine / retinal migraine) * migraine aura without headache * scint ...

. Presentations like central or paracentral

scotoma A scotoma is an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by a field of normal – or relatively well-preserved – vision. Every normal mam ...

Floaters Floaters or eye floaters are sometimes visible deposits (e.g., the shadows of tiny structures of protein or other cell debris projected onto the retina) within the eye's vitreous humour ("the vitreous"), which is normally transparent, or betwee ...

and

dyschromatopsia Color blindness or color vision deficiency (CVD) is the decreased ability to see color or differences in color. It can impair tasks such as selecting ripe fruit, choosing clothing, and reading traffic lights. Color blindness may make some aca ...

are less common. 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 Fovea () (Latin for "pit"; plural foveae ) is a term in anatomy. It refers to a pit or depression in a structure. Human anatomy *Fovea centralis of the retina * Fovea buccalis or Dimple * Fovea of the femoral head * Trochlear fovea of the fr ...

Optic disc The optic disc or optic nerve head is the point of exit for ganglion cell axons leaving the eye. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye. The ganglion cell axons form the ...

oedema may also seen occasionally.

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.

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 Fluorescein angiography (FA), fluorescent angiography (FAG), or fundus fluorescein angiography (FFA) is a technique for examining the circulation of the retina and choroid (parts of the fundus) using a fluorescent dye and a specialized camera. S ...

of the eye reveals characteristic punctate hyperfluorescent lesions in a wreath-like configuration surrounding the fovea. *

Indocyanine green angiography Indocyanine green angiography (ICGA) is a diagnostic procedure used to examine choroidal blood flow and associated pathology. Indocyanine green (ICG) is a water soluble cyanine dye which shows fluorescence in near-infrared (790–805 nm) range, wi ...

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

{{Medicine Disorders of choroid and retina Syndromes