Are There Two Forms of Multiple Evanescent White Dot Syndrome

PURPOSE To analyze the nature of multiple evanescent white dot syndrome (MEWDS) and differentiate an idiopathic or primary form of MEWDS from a secondary form that is seen in association with other clinical conditions affecting the posterior segment of the eye. METHODS Clinical and multimodal imaging findings including color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography and optical coherence tomography angiography of patients with secondary MEWDS are presented. RESULTS Seventeen consecutive patients with secondary MEWDS were evaluated. Thirteen patients were female. Most were young adults between the ages of 20 to 40 years old with myopia (less than -6 diopters). Pathologic conditions associated to the secondary MEWDS reaction were high myopia (greater than -6 diopters) in 1 eye, prior vitreoretinal surgery for rhegmatogenous retinal detachment in 1 eye and manifestations of MFC in 15 eyes. In all eyes the MEWDS lesions followed a course of progression and resolution independent from the underlying condition. CONCLUSION Secondary MEWDS appears to be an epiphenomenon ("EpiMEWDS") that may be seen in association with clinical manifestations disruptive to the choriocapillaris/Bruch's membrane/retinal pigment epithelium complex.