This 36YO male presented with flashes and a temporal scotoma in his left eye. Vision was 20/20 OD and 20/25 OS.
Optos color imaging shows multiple deep retinal white dots scattered throughout the posterior pole, which are hyper-autofluorescent.
Swept-source OCT shows nasal loss of the outer retinal bands with some hyperreflective spots. Visual fields show an enlarged left blind spot, consistent with the peripapillary hyperautofluorescence.
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), noted in our patient, is a classic pathognomonic finding.
Acutely, patients will also have an enlarged blind spot, often complaining of temporal visual field loss, due to the 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 two disorders were the same disease but with distinct findings at different points in time.
