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Multiple evanescent white dot syndrome

AI overview

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.

Key points
  • Typically affects healthy females aged 15-50
    source quote
    The typical patient with MEWDS is a healthy female aged between 15 and 50.
  • Women are affected four times more often than men
    source quote
    women are affected with MEWDS four times more often than men
  • Approximately one-third of patients have an antecedent viral prodrome
    source quote
    An antecedent viral prodrome occurs in approximately one-third of cases.
  • Etiology is unknown but viral and autoimmune origins have been postulated
    source quote
    The etiology of multiple evanescent white dot syndrome is currently unknown but two potential origins have been postulated.
  • May be associated with SARS COVID-19 Pfizer vaccine
    source quote
    MEWDS may be associated with the SARS COVID-19 Pfizer vaccine but more studies are needed.
  • Myopia is commonly seen in patients
    source quote
    Myopia is commonly seen in patients.
Symptoms
  • Acute unilateral painless decreased vision
    source quote
    Patients commonly present with acute unilateral painless decreased vision
  • Photopsias
    source quote
    Patients commonly present with acute unilateral painless decreased vision and photopsias
  • Multiple discrete white to orange spots at the level of the RPE or deep retina in perifoveal location
    source quote
    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
  • Optic disc oedema may be seen occasionally
    source quote
    Optic disc oedema may also seen occasionally.
Diagnosis
  • Visual field abnormalities include generalized depression, scotoma, and enlargement of blind spot
    source quote
    Visual field abnormalities are variable and include generalized depression of visual field, paracentral or peripheral scotoma and enlargement of the blind spot.
  • Fluorescein angiography reveals punctate hyperfluorescent lesions in wreath-like configuration around fovea
    source quote
    Fluorescein angiography of the eye reveals characteristic punctate hyperfluorescent lesions in a wreath-like configuration surrounding the fovea.
  • Indocyanine green angiography reveals hypofluorescent lesions in greater number than other studies
    source quote
    Indocyanine green angiography reveals hypofluorescent lesions in a greater number compared with other studies.
  • Fundus autofluorescence is a noninvasive method to demonstrate subretinal spots
    source quote
    Fundus autofluorescence (FAF) has been shown to be a noninvasive method to demonstrate the subretinal spots in MEWDS.
Treatment
  • Self-limited disease with excellent visual recovery within 2-10 weeks
    source quote
    MEWDS is a self limited disease with excellent visual recovery within 2-10 weeks.
  • Residual symptoms including photopsia may persist for months
    source quote
    However residual symptoms including photopsia may persist for months.
Prognosis

Self-limited disease with excellent visual recovery within 2-10 weeks, though residual symptoms including photopsia may persist for months.

AI-synthesized from the Wikipedia article “Multiple evanescent white dot syndrome”. Not medical advice. Verify source →
Multiple evanescent white dot syndrome
SpecialtyOphthalmology

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]

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]

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]

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]

  • Visual field abnormalities are variable and include generalized depression of visual field, paracentral or peripheral scotoma and enlargement of the blind spot.
  • Fluorescein angiography of the eye reveals characteristic punctate hyperfluorescent lesions in a wreath-like configuration surrounding the fovea.
  • Indocyanine green angiography 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.

MEWDS is a self limited disease with excellent visual recovery within 2-10 weeks. However residual symptoms including photopsia may persist for months.

  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.