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Updated: Feb 24, 2026

In Vivo Confocal Microscopy in the Diagnosis and Management of Dry Eye: A Focus on Imaging Protocols and Interpretation
Published on: November 11, 2025
Bilateral multiple evanescent white dot syndrome
Chiara Veronese1, Chiara Maiolo2, Mariachiara Morara3
1Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy. chveronese@yahoo.com.
Purpose:
To present a single case of bilateral multiple evanescent white dot syndrome (MEWDS).
Methods:
A single case with three months of follow-up using imaging studies including fundus color photography (FP), fluorescein angiography (FA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), en face SD-OCT and optical coherence tomography angiography (OCTA) is presented.
Results:
The patient presented with bilateral MEWDS, ultimately with complete resolution of symptoms. FP revealed foveal granularity and white punctate deep retinal spots, FA found early wreath-like hyperfluorescence, while ICGA showed hypofluorescent dots and spots in the early and late stages. FAF showed areas of hyperautofluorescence. SD-OCT revealed disruption of the ellipsoid zone (EZ) and accumulation of hyperreflective material of variable size and shape. En face SD-OCT demonstrated hyporeflective areas corresponding to areas of EZ disruption as well as hyperreflective dots in the outer nuclear layer. OCTA showed areas of photoreceptor slab black-out corresponding to areas of EZ disruption and light areas of flow void or flow disturbance in the choriocapillaris slab.
Conclusions:
This case represents an unusual case of bilateral MEWDS with complete resolution within three months.
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