The white dot syndromes

Abstract

Several entities must be considered when a patient presents with a white dot syndrome. In most cases these can be distinguished from one another based on the appearance or distribution of the lesions, the clinical course, or patient variables such as age, sex, laterality, and functional and image examinations. In this paper we review the distinctive and shared features of the white dot syndromes, highlighting the clinical findings, diagnostic test results, proposed etiologies, treatment, and prognosis.

Transient spectral domain optical coherence tomography findings in classic MEWDS: a case report

“…In the present case, FA demonstrated typical early hyperfluorescence with late RPE staining, corresponding to hypofluorescent areas in the late phase of ICGA (1,5) . These hypofluorescent areas showed moderately reflective focal lesions in the outer photoreceptor layer, where the macular photoreceptor IS-OS junction was disrupted by SD-OCT, which is associated with foveal granularity.…”

“…It was suggested the primary site of MEWDS is on the RPE (2,6) . With the clinical use of ICGA, MEWDS has become known as a choroidopathy, suggesting that the cause of the photoreceptors and RPE dysfunction is associated to decreased perfusion of the choriocapillaris (4)(5)(6)10) . This supposition is based on their angiographic pattern that demonstrated hypofluorescent lesions on ICGA that may appear even in normal areas on FA and funduscopy (6) .…”

“…Multiple evanescent white dot syndrome (MEWDS) is a benign self-healing disease with an unknown etiology that was first described in 1984 by Jampol et al It is a retinal pigment epithelial (RPE) and choroidal inflammatory condition that predominantly affects young to middle-aged women, is unilateral in 80% of cases, and causes visual loss of variable degrees (1)(2)(3)(4)(5) . Associated clinical features include flu-like prodrome, blurred disc margins, blind spot enlargement, and temporal scotomata (2,5) .…”

“…Associated clinical features include flu-like prodrome, blurred disc margins, blind spot enlargement, and temporal scotomata (2,5) . Fundoscopy typically reveals multiple, 100-200 µm yellow-white outer retina dots in posterior pole and mid-periphery as well as a unique foveal granularity (1,2,(4)(5)(6)(7) . Fluorescein angiography (FA) typical aspect comprises early foveal granular hyperfluorescence, early hyperfluorescence, and late staining of the white dots in a wreath-like pattern and disc capillary leakage.…”

White Dot Syndromes: A 20-year Study of Incidence, Clinical Features, and Outcomes

“…“White dot syndromes” (WDS) is a term that is used to describe a group of non-infectious retinal, retinal pigment epithelial and choroidal inflammatory conditions that include the following diseases: 1 Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)Serpiginous choroidopathyMultiple evanescent white dot syndrome (MEWDS) 2 Birdshot retinochoroidopathyMultifocal choroiditis and panuveitis syndrome (MCP) 3 Punctuate inner choroidopathy (PIC)Acute zonal occult outer retinopathy (AZOOR) 4 These entities are diagnosed based on medical history and clinical examination, 5 often presenting the clinician with a significant diagnostic challenge, 6 with some entities exhibiting interesting clinical and/or laboratory associations. 7 Management options and outcomes are also variable.…”