Multiple evanescent white dot syndrome

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Multiple evanescent white dot syndrome (MEWDS) is an uncommon inflammatory condition of the retina that typically affects otherwise healthy young females in the second to fourth decades of life. [1]

Contents

The typical patient with MEWDS is a healthy female aged between 15 and 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. [2]

Presentation

Patients commonly present with acute unilateral painless decreased vision and photopsias. [3] Presentations like central or paracentral scotoma, Floaters and dyschromatopsia are less common. [3] 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). Optic disc oedema may also seen occasionally. [3]

Cause

The etiology of multiple evanescent white dot syndrome is currently unknown but two potential origins have been postulated. Gass, et. al. suggests a virus invades retinal photoreceptors through cell-to-cell transmission via either the ora serrata or optic disc margin. [4] Alternatively, Jampol, et al. proposes an auto-immune origin in patients with certain genetic vulnerabilities to environmental triggers. [5] More recently, MEWDS may be associated with the SARS COVID-19 Pfizer vaccine but more studies are needed. [3] It has been seen in one case of COVID-19 infection. [6]

Diagnosis

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

  1. ↑ Maghsoudlou, P; Epps, SJ; Guly, CM; Dick, AD (28 May 2025). "Uveitis in Adults: A Review". JAMA. doi:10.1001/jama.2025.4358. PMID   40434762.
  2. ↑ Brian Toussaint MD (December 6, 2014). "Multiple Evanescent White Dot Syndrome". EyeWiki.
  3. 1 2 3 4 John F, Salmon (13 December 2019). "Uveitis". Kanski's clinical ophthalmology : a systematic approach (9th ed.). Elsevier. p. 484. ISBN   978-0-7020-7711-1.
  4. ↑ Gass, JDM (2002). "Acute zonal occult outer retinopathy: a long-term follow-up study". Am J Ophthalmol. 134 (3): 329–339. doi:10.1016/s0002-9394(02)01640-9. PMID   12208243.
  5. ↑ Jampol, Lee (Mar 2003). "White spot syndromes of the retina: a hypothesis based on the common genetic hypothesis of autoimmune/inflammatory disease". Am J Ophthalmol. 135 (3): 376–9. doi:10.1016/s0002-9394(02)02088-3. PMID   12614757.
  6. ↑ Peck, Travis. "A Case of MEWDS Following COVID-19 Infection". Retina Today. Retrieved 1 February 2023.
  7. Basic and Clinical Science Course; Intraocular inflammation and uveitis (2011-2012 ed.). American Academy of Ophthalmology. 2012. ISBN   978-1615251162.
  8. Basic and Clinical Science Course; Retina and vitreous (2011-2012 ed.). American Academy of Ophthalmology. 2012. ISBN   978-1615251193.
  9. Myron, Yanoff (2008). Ophthalmology (3rd ed.). Mosby. ISBN   978-0323057516.
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