A Case of Multiple Evanescent White Dot Syndrome in a Young Adult Male

Introduction: Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition characterized by numerous pale whitish dots in the posterior pole and the mid periphery. It is a unilateral disease that typically affects young to middle-aged female myopic adults. In up to 50% of cases, the condition is preceded by a flu-like viral episode. Although initial vision loss is variable, MEWDS is a self-limited disease with an excellent prognosis in terms of visual recovery. Most cases resolve without any treatment. We presents a rare case of MEWDS in a healthy young adult male without any preceding viral symptoms.

Case Study: The patient is a healthy 27-year-old myopic male with no past medical history who presented to an outpatient ophthalmology clinic with the chief complaint of decreased vision in his left eye. Several days prior to presentation, he noted a sudden increase in floaters with concurrent haziness in the left eye. Additionally, the patient reported that the vision in the left eye was "yellowed" compared to the right. On examination, vision was OD 20/20 and OS 20/50. Intraocular pressures were within normal limits. Slit lamp examination of the left eye was normal without evidence of intraocular inflammation. Fundoscopy was grossly unremarkable. Fluorescein angiography revealed areas with early punctate hyperfluorescence in a “wreath-like pattern” and late staining, and autofluorescence showed hyperautofluorescent patchy lesions. This constellation of findings was most suggestive of MEWDS. The patient was managed with close monitoring and observation with serial follow-up visits. By seven months after presentation, the vision in the left eye had improved to 20/20 with a notable decrease in subjective floaters, haziness, and "yellowing" of the vision. Further imaging with fundus autofluorescence demonstrated resolution of the patchy hyperautofluorescent lesions throughout the posterior pole.

Discussion: Patients describing a unilateral decrease in vision with photopsia, in the context of foveal granularity without significant inflammation, with angiographic early punctate hyperfluorescence in a wreath-like pattern and late staining, should alert the clinician to MEWDS. This relatively uncommon condition is typically self-limited and affects young women more than men in a 4:1 ratio. While the pathogenesis is unknown, the prognosis is excellent. One of the tenants of osteopathic medicine is that the body is capable of self-regulation, self-healing, and health maintenance. Most patients recover their vision without requiring treatment, although many describe a persistent enlarged blind spot. Approximately 10% of patients experience a recurrence at a later point in time.