Optic disc pit: A trigger for secondary multiple evanescent white dot syndrome

We describe a case of secondary multiple evanescent white dot syndrome (MEWDS) with optic disc pit as the underlying triggering pathology.

Observational case report.

A 41-year-old well man with a background of right optic disc pit presented with right eye loss of vision and photopsia. Visual acuity at presentation was 20/100. He was found to have clinical and multimodal imaging features consistent with right unilateral MEWDS, and the spatial distribution of lesions made it likely that the optic disc pit was the trigger. Fundus autofluorescence revealed hyperautofluorescent 'spots' that gradually faded over serial imaging, with the complete absence of hyperautofluorescent 'dots'. Over three months of follow-up visual acuity recovered to 20/25.

Optic disc pit may act as a trigger for secondary MEWDS, which is an increasingly recognized epiphenomenon. Secondary MEWDS may present as 'spots without dots', and we hypothesize that this feature may differentiate it from primary MEWDS.