1. Multiple Evanescent White Dot Syndrome (MEWDS)
Dr. Padmamalini Mahendradas
Dr. Kavitha Avadhani
Department of Uveitis & Ocular Immunology
Narayana Nethralaya,
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 Presentation Ocular 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