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40 year old woman with a five-day history of visual loss in the right eye
Digital Journal of Ophthalmology 1997
Volume 3, Number 28
November 14, 1997
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Anthony J. Aldave, M.D. | Wills Eye Hospital, Philadelphia, PA
Diagnosis and Discussion
Multiple Evanescent White Dot Syndrome (MEWDS)

The patient was felt to have multiple evanescent white dot syndrome and was followed conservatively without treatment. The patient has since experienced a gradual improvement in her visual symptoms with a concomitant resolution of the white lesions.
MEWDS, first described in 1984, most commonly affects healthy younger women, as is true in this patient's case. Typically, patients present with rapidly progressive unilateral visual loss. Had formal visual field testing been performed, it is likely that an enlarged blind spot would have been demonstrated. Other characteristic clinical findings in MEWDS, which were not noted in this patient, include a granular appearance of the macula, optic disc edema, retinal vascular sheathing, and vitreal cells.

Although the cause of MEWDS remains unknown, ophthalmoscopic localization of the lesions to the deep retina and abnormal electroretinographic studies have pointed to a disorder of the retinal pigment epithelium which secondarily affects the adjacent photoreceptors. Fluorescein angiography is often a valuable tool in confirming a diagnosis of MEWDS in a patient with characteristic fundus findings. Interestingly, this patient did not display the typical early hyperfluorescent spots of MEWDS, but instead had hypofluorescent lesions, which are more characteristic of APMPEE. Although the fundoscopic appearance of the lesions was strongly suggestive of MEWDS, a recovery angiogram would be helpful in confirming the diagnosis; one would expect significantly less RPE alteration than is seen after resolution of APMPEE. Investigators have also suggested that indocyanine green angiography (ICG) may be a useful adjunct in the diagnosis of MEWDS, as it demonstrates a greater number of lesions than are seen with ophthalmoscopy or fluoroscein angiography.

MEWDS is usually a self-limited disorder, with resolution of symptoms and the white dots over a 4 to 6 week period. However, a chronic recurrent form of the disease has been described in which multiple recurrences have involved both eyes Additionally, multifocal choroiditis and choroidal neovascularization have been associated with MEWDS, as has persistent enlargement of the blind spot. Patients with acute idiopathic blind spot enlargement (AIBSE) without optic disc edema are likely a subgroup of patients with MEWDS who have rapid resolution of their fundoscopic abnormalities with a protracted enlargement of the blind spot. When these patients are examined after resolution of the white dot lesions and the characteristic fluorescein angiographic findings, the presentation is indistinguishable FROM AIBSE, suggesting that AIBSE may represent a variation of MEWDS.
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