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Ophthalmology and Visual Sciences

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Multiple evanescent white dot syndrome (MEWDS)

Figure 1

Contributors: Mahsaw Motlagh, MD

Photographer: Brice Critser, CRA, OCT-C, FOPS

Posted July 12, 2021

A 44-year-old Japanese male presented for evaluation of a "gray spot" involving his central vision in the right eye. Examination revealed fine orange granularity of the central macula in the right eye. This patient had a known diagnosis of MEWDS and therefore a diagnosis of recurrence was made based on the clinical findings.

Color fundus photography of the right eye (left panel) shows subtle foveal granularity, and the left eye is normal (right panel)

Figure 1: Color fundus photography of the right eye (left panel) shows subtle foveal granularity, and the left eye is normal (right panel).

OCT of the right eye (top panel) shows a normal retinal contour but with focal hyperreflective abnormalities in the outer retina disrupting the ellipsoid zone centrally. The left eye (bottom panel) demonstrates normal retinal contour and striations

Figure 2: OCT of the right eye (top panel) shows a normal retinal contour but with focal hyperreflective abnormalities in the outer retina disrupting the ellipsoid zone centrally. The left eye (bottom panel) demonstrates normal retinal contour and striations.


Figure 2

Contributors: Mahsaw Motlagh, MD

Photographer: Brice Critser, CRA, OCT-C, FOPS

Posted July 12, 2021

A 19-year-old female presented with acute onset blurry vision in the right eye with associated changes in color vision and intermittent central photopsias. Examination was remarkable for an orange, granular appearance of the macula and faint circular lesions of the posterior pole in the right eye only. Based on additional testing, a diagnosis of multiple evanescent white dot syndrome (MEWDS) was made. For more information on MEWDS, see the EyeRounds MEWDS case reports.

Color fundus photos of the right eye and left eye

Figure 1: Color fundus photos of the right eye (left panel) demonstrated a small, structurally congested optic disc with mild optic disc edema in addition to an orange granular appearance of the macula. There were also multiple faint circular lesions throughout posterior pole, most prominent in the temporal macula. The left eye (right panel) similarly demonstrated a small, structurally congested optic disc but was otherwise normal.

Optical coherence tomography (OCT) macula

OCT of the right and left eyes

Figure 2: OCT of the right eye (top panel) shows a subtle stippled inner segment/outer segment (IS/OS) junction and normal foveal contour without edema. The left eye (bottom panel) shows normal foveal contour and normal retinal architecture.

Fundus autofluorescence (FAF)

Fundus autofluorescence of the right and left eyes

Figure 3: Fundus autofluorescence of the right eye (left panel)shows multiple foci of hyperautofluorescence throughout the posterior pole concentrated most in the temporal macula while the left eye (right panel) is relatively normal.

Fluorescein angiography (FA)

Fluorescein angiography (FA) of the right eye demonstrates multiple small foci of early and late hyperfluorescence in a wreath-like pattern

Figure 4: FA of the right eye demonstrates multiple small foci of early and late hyperfluorescence in a wreath-like pattern (red arrows) corresponding to the lesions seen on FAF.


Figure 3

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.

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 4

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 5

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: 07/12/2021
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