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Uveitis

Case 15

 

Patient Presentation: A 36-year-old woman presented with a 2-week history of “blurry spots” and flashing lights in her left eye. She denied a painful red eye, floaters or a visual field deficit. There was no history of trauma. Her past medical history was unremarkable, and she did not take any medications. She did report having a seasonal flu 1 month ago.

On examination, her visual acuity was 20/20 OD and 20/40 OS. IOP was 13 OD and 14 OS, and there was no RAPD. Slit-lamp examination was normal. Optos widefield fundus photos were taken and are shown below:

Question 1: Describe the findings in the fundus photographs above.

An OCT of the macula was performed in OU and is shown below:

Question 2: What is the main finding in the OCT macula in OS shown above?

Question 3: Based on the patient presentation, fundus photos and OCT macula imaging, what is the most likely diagnosis?

Question 4: What is the next best imaging modality to confirm this patient’s diagnosis?

Question 5: What is the next best step in the management of this patient?

References:

1. Marsiglia M, Gallego-Pinazo R, Cunha de Souza E, et al. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging. Retina. 2016;36(1):64-74. doi:10.1097/IAE.0000000000000685

2. Papasavvas I, Mantovani A, Tugal-Tutkun I, Herbort CP Jr. Multiple evanescent white dot syndrome (MEWDS): update on practical appraisal, diagnosis and clinicopathology; a review and an alternative comprehensive perspective. J Ophthalmic Inflamm Infect. 2021;11(1):45. Published 2021 Dec 18. doi:10.1186/s12348-021-00279-7

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Learning Objectives:

  1. To understand the clinical presentation and prognosis in MEWDS

  2. To understand the fundus and OCT findings in MEWDS

  3. ​To understand the utility of multi-modal imaging in the setting of diagnostic uncertainty

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