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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
Differential Diagnosis
Multiple evanescent white dot syndrome (MEWDS)
Features: Typically occurs in younger women, with frequent recovery of visual function and resolution of RPE lesions.
Noted on ophthalmoscopy: Lesions normally unilateral, multiple white dots are seen at the level of the deep retina or retinal pigment epithelium. The white dots are most prominent in the paramacular area, usually sparing the fovea.
Noted on fluorescein angiography: MEWDS lesions usually demonstrate early punctate hyperfluorescence and late staining corresponding to the location of the white dots and mild disc staining.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)
Features: Transient visual loss in younger patients, with frequent recovery of visual function and resolution of RPE lesions. Usually bilateral involvement.
Noted on ophthalmoscopy: Usually bilateral, with considerably larger lesions than those associated with MEWDS which leave more obvious RPE alterations after fading
Noted on fluorescein angiography: APMPPE lesions block fluorescence early in the angiogram with late staining.

Acute retinal pigment epitheliitis
Features: Acute visual loss in younger patients, with near total visual recovery in 7-10 weeks.
Noted on ophthalmoscopy: Lesions appear as dark dots with surrounding halo of depigmentation; these spots become more pigmented with clinical recovery.
Noted on fluorescein angiography: Appear as hypofluorescent areas surrounded by hyperfluorescence.

Birdshot retinochoroidopathy
Features: Appears in older patients and is bilateral. Does not present with acute loss of vision.
Noted on ophthalmoscopy: Manifests as multiple cream-colored lesions at the level of the RPE or deeper. Frequently associated with cystoid macular edema, vitreous reaction, and retinal vascular leakage.
Noted on fluorescein angiography: Characteristically, reveals hypofluorescence in the early phase with slight diffuse hyperfluorescence in the late phase.
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