University of Iowa Health Care

Ophthalmology and Visual Sciences

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Multiple evanescent white dot syndrome (MEWDS)

Contributor: Jesse Vislisel, MD; Karen Gehrs, MD

Photographer: Carol Chan, CRA

Multiple evanescent white dot syndrome (MEWDS) results from idiopathic inflammation of the retina. It is most common in healthy, young, white, myopic females and typically has an acute and unilateral presentation. As seen in the photograph, the condition causes multiple, discrete, gray-white spots in the outer retina or retinal pigmented epithelium (RPE). There are pathognomonic granular changes within the fovea. Mild intraocular inflammation may be present. Fundus fluorescein angiography (FFA) shows early punctate hyperfluorescence with late staining of the lesions arranged in a "wreath-like" configuration around the fovea. Optical coherence tomography (OCT) shows disruption of the outer retinal layers. The condition is self-limited with an excellent visual prognosis.

Figure 1

As seen in the photograph, the condition causes multiple, discrete, gray-white spots in the outer retina or retinal pigmented epithelium (RPE).

Fundus fluorescein angiography (FFA) shows early punctate hyperfluorescence with late staining of the lesions arranged in a "wreath-like" configuration around the fovea

Fundus fluorescein angiography (FFA) shows early punctate hyperfluorescence with late staining of the lesions arranged in a "wreath-like" configuration around the fovea

Multiple evanescent white dot sybdrome, Optical coherence tomography (OCT) shows disruption of the outer retinal layers


Figure 2

Contributor: Jeffrey Welder, MD

Photographer: Brice Critser, CRA

MEWDS photo montage

A 25-year-old male presented with 3 days of painless scotoma and photopsia in the left eye. Amsler grid testing revealed an enlarged blindspot. Fundus examination showed multiple subretintal white spots. Fluorescein angiography showed classic punctate hyperfluorescence in a wreath-like pattern in the left eye (photo at bottom of page). A diagnosis of MEWDS was made.

Fundus, right (normal) and left (abnormal)
right eye left eye
right left

Fluorescein angiography


Figure 3

Contributor: Luke Lenci, MD

Photographer: Brice Critser, CRA

This case represents the more severe end of the spectrum for MEWDS. This young, myopic female presented with a complaint of unilateral shimmering photopsias and a paracentral scotoma. Her exam showed the pathognomic subfoveal yellow/orange granularity in the right eye along with an FFA that had a classic "wreathlike" hyperfluorescence. Disc edema is also seen in the right eye.

Fundus Photos, both eyes

right eye. subfoveal yellow/orange granularity and disc edema left eye
right eye left eye

Right eye

FFA that had a classic "wreathlike" hyperfluorescence

Goldmann visual fields



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last updated: updated: 11-03-2015