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Updated: Jun 15, 2025
Multifocal Electroretinograms
Published on: December 4, 2011
Multiple Evanescent White Dot Syndrome as Epiphenomenon of Infectious Chorioretinopathies
Luca De Simone1, Vanessa Ferraro2, Elena Bolletta1
1Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Purpose:
Multiple evanescent white dot syndrome (MEWDS) is a rare idiopathic ocular disorder often affecting young adults. Recently, a secondary form, epiphenomenon MEWDS (Epi-MEWDS), has been described in association with pre-existing retinal conditions. However, its correlation with infectious diseases remains poorly documented.
Methods:
A retrospective review of six patients with infectious chorioretinopathies who developed Epi-MEWDS was conducted. Clinical presentations, imaging findings, and disease progression were analyzed.
Results:
This study presents a case series of six patients who developed Epi-MEWDS secondary to infectious chorioretinopathies, highlighting its distinct clinical features. Cases included Epi-MEWDS following Candida endophthalmitis, tubercular multifocal serpiginous-like choroiditis, ocular syphilis, and recurrent toxoplasmosis. Fundus autofluorescence and optical coherence tomography confirmed hyperautofluorescent lesions and outer retinal disruption in all cases. Patients were managed conservatively, and in all cases, imaging abnormalities resolved within a few weeks.
Conclusion:
This case series emphasizes the role of infectious disease-related immune responses in triggering Epi-MEWDS. In these cases disruptions in the outer blood-retinal barrier, leading to photoreceptor antigen exposure, appear to contribute to disease pathogenesis. Recognizing these cases can enhance understanding of post-infectious retinal immune responses and guide appropriate clinical management.
Insights
Infectious diseases can trigger epiphenomenon MEWDS (Epi-MEWDS), a secondary form of white dot syndrome. This immune response causes outer blood-retinal barrier disruptions, leading to photoreceptor antigen exposure and retinal inflammation.
Area of Science:
- Ophthalmology
- Immunology
- Infectious Diseases
Background:
- Multiple evanescent white dot syndrome (MEWDS) is a rare idiopathic ocular condition.
- Epiphenomenon MEWDS (Epi-MEWDS) is a recently described secondary form associated with retinal conditions.
- The link between Epi-MEWDS and infectious diseases is not well-documented.
Purpose of the Study:
- To investigate the correlation between infectious chorioretinopathies and the development of Epi-MEWDS.
- To describe the clinical features and outcomes of Epi-MEWDS secondary to infections.
Main Methods:
- Retrospective review of six patients with infectious chorioretinopathies who developed Epi-MEWDS.
- Analysis of clinical presentations, imaging findings (fundus autofluorescence, optical coherence tomography), and disease progression.
Main Results:
- Epi-MEWDS was observed secondary to Candida endophthalmitis, tubercular multifocal serpiginous-like choroiditis, ocular syphilis, and recurrent toxoplasmosis.
- All cases showed hyperautofluorescent lesions and outer retinal disruption on imaging.
- Conservative management led to resolution of imaging abnormalities within weeks.
Conclusions:
- Infectious disease-related immune responses can trigger Epi-MEWDS.
- Disruptions in the outer blood-retinal barrier and photoreceptor antigen exposure contribute to pathogenesis.
- Recognizing these cases improves understanding of post-infectious retinal immunity and clinical management.
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