Clinical findings and management of multiple evanescent white dot syndrome

This case report presents the diagnosis and management of a patient who was ultimately diagnosed as having multiple evanescent white dot syndrome (MEWDS), a rare retinal inflammatory disorder classified under the white dot syndromes.

A 34-year-old Hispanic woman presented with chief complaints of flickering lights and spots in her right eye that started 2 weeks earlier. Retinal examination revealed multiple white dots scattered across the retina, with an accompanying foveal granularity. Spectral domain optical coherence tomography and fundus autofluorescence were performed, which confirmed the diagnosis of MEWDS. The patient was monitored without treatment until resolution.

The etiology and pathogenesis of MEWDS remain unknown; fortunately, the natural course of the disease is favorable because almost all patients retain a good outcome without the need for treatment. This case highlights the importance of considering MEWDS and other white dot syndromes in the differential diagnosis of patients who present with a history of photopsia. Because many clinical findings are absent or very subtle when patients present, the clinician should consider supplemental testing such as spectral domain optical coherence tomography and fundus autofluorescence in aiding in the diagnosis.