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Review
. 2025 Jul 16;25(1):413.
doi: 10.1186/s12886-025-04231-4.

Multiple evanescent white dot syndrome associated with focal scleral nodule: a case report and literature review

Abdulla Sawut #  1 , Yang Meng #  1 , Tsering Lhamo  1 , Di Xiao  1 , Yu Su  2 , Changzheng Chen  3
Affiliations
Review

Multiple evanescent white dot syndrome associated with focal scleral nodule: a case report and literature review

Abdulla Sawut et al. BMC Ophthalmol. .

Abstract

Background: Multiple evanescent white dot syndrome (MEWDS) is a rare transient inflammatory retinopathy characterized by discrete white dots disseminated on the fundus. Focal scleral nodule (FSN) typically presents as a stable, solitary, yellow-white, subretinal lesion arising from the sclera. This article reports a rare case of MEWDS associated with FSN in a young female.

Case presentation: A 34-year-old female presented with a complaint of gradually enlarging paracentral scotomas in the left eye for 8 days. At presentation, best-corrected visual acuity (BCVA) was 20/25 in the left eye. Fundus examination of the left eye revealed optic disc edema and an orange-yellow irregular lesion on the infratemporal side of the fovea. The multimodal imaging (MMI) findings revealed a rather typical MEWDS-like reaction and a subretinal lesion located at the sclera. After thorough consideration, the patient was diagnosed with MEWDS associated with FSN. Corticosteroid therapy was then administered to the patient. After 11 weeks, her BCVA recovered to 20/20 in the left eye, and the visual field defect had improved. Additionally, the MEWDS-like reaction had significantly recovered. The FSN remained stable during the 18-month follow-up.

Conclusions: This is the first reported case of MEWDS associated with FSN, expanding the understanding of both conditions.

Keywords: Case report; Focal scleral nodule; MEWDS-like reaction; Multiple evanescent white Dot syndrome; Review; Secondary MEWDS.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in accordance with the tenets of the Declaration of Helsinki. Consent to participate was not applicable due to the retrospective design of this study. Consent for publication: Written informed consent was obtained from the patient for the publication of this report and the accompanying images. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Baseline UW-cSLO, OCT, and FA examinations. UW-cSLO of the left eye revealed optic disc edema and an orange-yellow irregular lesion on the infratemporal side of the fovea (A). OCT revealed optic disc edema, peripapillary SRF (blue arrowhead), and elevation of the RPE over a subretinal mass on the infratemporal side of the fovea (orange arrowhead). The location of the elevation corresponded to the orange-yellow lesion observed in UW-cSLO. Additionally, there was disruption of the RPE and EZ above the mass (white arrowhead) (B). FA revealed hyperfluorescent changes around the optic disc from the early stage, with disc leakage at the late stage. Throughout all stages, dense hyperfluorescent dots were observed around the optic disc, mainly on the superior and nasal sides. Additionally, a hyperfluorescent lesion was observed on the infratemporal side of the fovea (red arrowhead) (C)
Fig. 2
Fig. 2
UW-cSLO, EDI-OCT, ICGA, FA, FAF and Humphrey visual field examinations at the first visit. UW-cSLO of the left eye revealed optic disc edema and an orange–yellow irregular lesion on the infratemporal side of the fovea. Multiple white dots can be observed mainly at the posterior pole and around the optic disc (A). EDI-OCT revealed a significant decrease in the peripapillary SRF (red arrowhead) and EZ attenuation in this area (blue arrowhead). OCT also revealed fragmentation of the EZ on the temporal side of the fovea (green arrowheads). The subretinal lesion on the infratemporal side of the fovea was clearly demonstrated as a homogeneous, hyperreflective, nodular mass that originated from the sclera and was overlain by a thinned choroid (orange arrowhead). The disruption of the RPE layer and EZ above the mass was aggravated (white arrowhead). (B). Late-phase ICGA revealed a hypofluorescent area around the optic disc surrounded by multiple hypofluorescent spots and dots (C). Late-phase FA revealed hyperfluorescent changes around the optic disc and multiple hyperfluorescent dots, colocalizing with, but were fewer in number than hypofluorescent dots in ICGA (D). FAF showed hyperautofluorescent dots, which colocalized with but were fewer in number than the hypofluorescent spots in ICGA (E). Humphrey visual field demonstrated an enlarged blind spot and a small in-ferotemporal visual field defect (F)
Fig. 3
Fig. 3
UW-cSLO, OCT, ICGA, FA, and FAF examinations at the 11-week follow-up. UW-cSLO of the left eye revealed that the orange–yellow irregular lesion (green arrowhead) remained unchanged, while disc edema had significantly recovered, and white dots and spots had disappeared (A). EDI-OCT revealed remarkable recovery of the EZ and RPE layers; however, the RPE above the mass did not fully recover. The subretinal mass remained stable (B). ICGA, FA, and FAF showed no obvious abnormalities except for a fluorescence anomaly corresponding to the orange–yellow irregular lesion (blue, white and yellow arrowheads), which was considered to be the FSN (C-E)
Fig. 4
Fig. 4
EDI-OCT examinations of the FSN lesion level during the follow-up. The disruption of the EZ and RPE layers was remarkably recovered. The elevation of the RPE and the subretinal mass remained stable
Fig. 5
Fig. 5
EDI-OCT examinations of the macular level during follow-up. The integrity of the EZ had significantly recovered
See this image and copyright information in PMC

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