MEWDS

Classification according to ICD-10
H35.0	Retinopathies of the fundus and changes in the retinal vessels
ICD-10 online (WHO version 2019)

The multiple evanescent white dot syndrome (German: syndrome of fleeting white spots), abbreviated MEWDS , is an inflammatory disease of the retina . It belongs to the group of white dot syndromes and is associated with yellowish-white lesions on the retina, which are usually noticeable in those affected by visual disturbances . In most cases, these lesions appear on the pigment epithelium or on the outer retina.

The first description comes from 1984 by the US ophthalmologist Lee M. Jampol and colleagues.

frequency

Fleeting white spot syndrome is a rare condition. It is estimated that around two in 1 million people in the United States suffer from it , with women four to five times more likely to get the disease than men.

There are no reliable statistics on this syndrome in Germany, but the disease seems to be more common in women in this country too. Furthermore, younger people are more often affected by MEWDS than older people. Most patients are women between the ages of 20 and 40 who are otherwise healthy. It is also noticeable that in many cases there is also myopia , which, however, was present before the syndrome occurred.

causes

A certain cause for MEWDS has not yet been found. However, there is a suspicion that there is a connection between the syndrome and immunological processes. It turned out that many of the patients an associate before the emergence of MEWDS viral prodrome had. Around half of patients report flu-like symptoms that appeared before the symptoms of the syndrome. Some patients also report that they received a vaccination shortly before the white spots appeared on the retina .

Overall, it is therefore assumed that a combination of immunological processes, viruses and genetic predispositions play a role in the development of the disease.

Symptoms

Fleeting white spot syndrome often begins with flu-like symptoms such as headache, body aches, or fever. Visual field defects, which are usually one-sided, are also typical of the disease. In addition, patients perceive flashes of light or points of light. In addition, there is usually a deterioration in vision, which is also usually limited to one side.

The acute appearance of the symptoms and the unilateral appearance of the complaints are typical of this disease. If symptoms appear in both eyes, in most cases they are still different and not symmetrical. The syndrome is usually painless.

The ophthalmological examination

The ophthalmological examination includes the anamnesis, during which the first suspicion of the disease is raised, as well as the funduscopy . This shows white, point-like changes on the rear pole and orange-white, granular changes on the macula (yellow spot) of the eye. In most cases, the disease only affects one eye.

An examination of the vitreous usually reveals an accumulation of cells floating there, which leads to an additional deterioration in vision. In addition, the multiple evanescent white dot syndrome may cause the papilla - the point where the optic nerve emerges - to swell.

There are a number of other diagnostic methods that confirm the diagnosis of MEWDS:

With fluorescence angiography , a ring-shaped, point-like hyperfluorescence is noticeable if MEWDS is in the initial stage. If the disease is at an advanced stage, this imaging procedure reveals discoloration, which marks the actually white spots.
The indocyanine green angiography shows pronounced hypofluorescent spots peripapillary and in the area of white spots.
When examining the visual field , the blind spot is enlarged in this syndrome.
Auto fluorescence images , marked in a special camera metabolic waste products that have accumulated in the eye in the region of the white spots show hyperautofluoreszente spots on the posterior pole, which correlated with the white spots on the fundus.
In the optical coherence tomography (OCT short) show up subtle breaks in the photoreceptor inner and outer segment connections.
A multifocal electroretinogram (ERG for short), which shows the electrical potentials that occur in the retina, shows functional failures in the disease. In the Ganzfeld ERG, reduced a-waves and a longer receptor potential recovery time can be seen.

Differential diagnoses

There are a few other conditions that can cause white spots on the back of the eye. Must be distinguished, in addition to other diseases from the group of White Dot Syndrome the subretinal fibrosis and sarcoidosis .

therapy

As yet there is no specific treatment for fleeting white spots syndrome. It is possible to use steroids , but these have little effect.

Often, however, this is not necessary because the multiple evanescent white dot syndrome is a self-limiting disease. This means that the symptoms will usually go away without treatment. This is usually the case after a few weeks to months.

forecast

The multiple evanescent white dot syndrome generally has a very good prognosis : in most cases, the symptoms will disappear within the next few weeks or months even without treatment. The eyesight also usually returns completely. The average time to full recovery is around three to ten weeks.

The multiple evanescent white dot syndrome only causes consequential damage in rare cases. There may be scarring of the retina of the eye or an enlarged blind spot. A relapse or a chronic course of the disease is also conceivable, but very rare.

literature

F. Pellegrini, E. Interlandi: A case of multiple evanescent white dot syndrome misdiagnosed as optic neuritis: Differential diagnosis for the neurologist. In: Journal of neurosciences in rural practice. Volume 7, number 2, 2016 Apr-Jun, pp. 283-285, doi: 10.4103 / 0976-3147.178658 , PMID 27114663 , PMC 4821940 (free full text).
U. Schönherr & GE Lang: Multiple evanescent white dot syndrome In: Spektrum der Augenheilkunde , Vol. 4, No. 4, pp. 154-158 doi: 10.1007 / BF03163590

Web links

Webeye (English)
Lux Eye Center (German)

Individual evidence

↑ ^a ^b Multiple Evanescent White Dot Syndrome - EyeWiki. Retrieved October 21, 2019 .
↑ LM Jampol, PA Sieving, D. Pugh, GA Fishman, H. Gilbert: Multiple evanescent white dot syndrome. I. Clinical findings. In: Archives of ophthalmology. Volume 102, Number 5, May 1984, pp. 671-674, doi: 10.1001 / archopht.1984.01040030527008 , PMID 6721749 .
↑ Uwe Pleyer: Inflammatory eye diseases . Ed .: Prof. Dr. Uwe Pleyer. Springer-Verlag, Berlin-Heidelberg 2014, ISBN 978-3-642-38418-9 , pp. 436-437 .

[Eyewiki-1] Multiple Evanescent White Dot Syndrome - EyeWiki. Retrieved October 21, 2019 .

[2] LM Jampol, PA Sieving, D. Pugh, GA Fishman, H. Gilbert: Multiple evanescent white dot syndrome. I. Clinical findings. In: Archives of ophthalmology. Volume 102, Number 5, May 1984, pp. 671-674, doi: 10.1001 / archopht.1984.01040030527008 , PMID 6721749 .

[3] Uwe Pleyer: Inflammatory eye diseases . Ed .: Prof. Dr. Uwe Pleyer. Springer-Verlag, Berlin-Heidelberg 2014, ISBN 978-3-642-38418-9 , pp. 436-437 .