This 30YO male presented with a one-day history of seeing “dots” in his vision. Vision was 20/25 OD and 20/20 OS.
There are multiple deep retinal white dots scattered throughout the posterior pole of each eye. The Optos green channel best shows these white dots compared to the color images. The spots disappear with the Optos red channel, confirming their retinal localization.
Fluorescein angiography shows variable early hypofluorescence with late staining of the lesions.
Learning Points:
Multiple evanescent white dot syndrome (MEWDS) presents with usually unilateral idiopathic inflammation of the outer retina that typically occurs in young, healthy myopic females.
The granular fovea (Jampol spots, named in honor of Dr. Lee Jampol, who first described this syndrome in 1984), not well imaged in our case, is a classic pathognomonic finding.
Acute cases will also have an enlarged blind spot, often with temporal visual field loss, due to peripapillary inflammation.
The white dots disappear within a week or two, which is why the lesions are called “evanescent”. However, the blind spot may persist for many months, well after the fundus appearance has normalized.
This stage of MEWDS was originally called the Acute idiopathic blind spot enlargement (AIBSE) syndrome before Gass recognized that the 2 disorders were the same disease but with distinct findings at different points in time.
