Transcript First Presentation - Fundus Examination

Multiple Evanescent White Dot
Syndrome (MEWDS)
Dr. Padmamalini Mahendradas
Dr. Kavitha Avadhani
Department of Uveitis & Ocular Immunology
Narayana Nethralaya,
Bangalore
Ocular and General History
 42 year old Asian Indian
 Complaints of sudden blurring of vision
associated with flashes in her left eye for
the past 4 days.
 No other systemic illness or preceding flu
At Presentation
Ocular Examination
 Visual acuity 1.0, N6 in both eyes
 IOP was within normal limits in OU
 OD: Normal
 OS: Anterior segment was quiet
First Presentation - Fundus Examination
 Yellowish white dots in the deep retina in both the
posterior pole and up to the mid periphery in the left
eye and
 foveal granularity
First Presentation –
FFA and Autofluorescence
 Fluorescein angiography: stippled hyperfluorescence
corresponding to the yellow white lesions
 Autofluorescence: many more lesions than seen clinically as
hyperfluorescent areas.
First presentation – Visual Fields
 Enlarged blind spot
First presentation - OCT
 Spectral Domain OCT through the lesions shows a disruption in
the IS/OS junction with focal hyper reflectivity and vitreous cells
indicates that the photoreceptor layer is involved and corroborates
well with electrophysiology findings seen in MEWDS suggesting
that MEWDS occurs in the outer retina and/or retinal pigment
epithelium
Diagnosis
OS: Multiple Evanescent White Dot
Syndrome (MEWDS)
Follow up – 5 Weeks
 Five weeks after the initial presentation nearly all
lesions seen clinically had disappeared
 Visual field showed disappearance of the scotoma
Follow-up OCT – after 5 weeks
• OCT reveals disappearance of posterior
vitreous cells
 Disappearance of posterior vitreous cells
and restoration of outer retinal layers
Discussion
 MEWDS is an inflammatory choriocapillaropathy of
unknown origin first described in 1984 by Jampol et
al.*
 It affects young females and a flu like illness may
precede the disease.
 Patients of MEWDS typically present with
complaints of decreased vision and scotoma.
 Spontaneous recovery without any treatment in 1 to
2months
*Jampol LM et al: Multiple evanescent white dot syndrome.
Arch Ophthalmol 1984;102:671-4.
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