Multiple evanescent white dot syndrome: Bilateral disease may be silent and asymmetric

PURPOSE: We report a patient with unilateral symptoms presenting with bilateral multiple evanescent white dot syndrome (MEWDS) in order to highlight the utility of multimodal imaging in revealing asymptomatic lesions in the fellow eye and underscore the importance of looking for silent bilateral disease. OBSERVATIONS: A 39-year-old man presented with blurry vision and photopsias in the left eye (OS). Funduscopic examination revealed characteristic granular white dots in the posterior pole OS. Multimodal imaging included fundus autofluorescence, which revealed numerous hyperautofluorescent lesions in both eyes, more than appreciated on clinical examination alone and corresponding ellipsoid disruption on OCT. Seven bilateral cases have been previously reported, all of which are asymmetric, similar to the case reported and are summarized here. CONCLUSIONS AND IMPORTANCE: While MEWDS is most often thought of as a unilateral disease, it may rarely present bilaterally as in the case presented here. Multimodal imaging is especially useful in diagnosis and follow-up. Fundus autofluorescence may be the most sensitive and practical test for detecting MEWDS, revealing lesions in the absence of white dots on clinical exam.