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

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

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

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

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.

First presentation – Visual Fields Enlarged blind spot

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

Diagnosis OS: Multiple Evanescent White Dot Syndrome (MEWDS)

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

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

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.

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