Multiple Evanescent White Dot Syndrome as Epiphenomenon of Infectious Chorioretinopathies

PURPOSE: Multiple evanescent white dot syndrome (MEWDS) is a rare idiopathic ocular disorder often affecting young adults. Recently, a secondary form, epiphenomenon MEWDS (Epi-MEWDS), has been described in association with pre-existing retinal conditions. However, its correlation with infectious diseases remains poorly documented. METHODS: A retrospective review of six patients with infectious chorioretinopathies who developed Epi-MEWDS was conducted. Clinical presentations, imaging findings, and disease progression were analyzed. RESULTS: This study presents a case series of six patients who developed Epi-MEWDS secondary to infectious chorioretinopathies, highlighting its distinct clinical features. Cases included Epi-MEWDS following Candida endophthalmitis, tubercular multifocal serpiginous-like choroiditis, ocular syphilis, and recurrent toxoplasmosis. Fundus autofluorescence and optical coherence tomography confirmed hyperautofluorescent lesions and outer retinal disruption in all cases. Patients were managed conservatively, and in all cases, imaging abnormalities resolved within a few weeks. CONCLUSION: This case series emphasizes the role of infectious disease-related immune responses in triggering Epi-MEWDS. In these cases disruptions in the outer blood-retinal barrier, leading to photoreceptor antigen exposure, appear to contribute to disease pathogenesis. Recognizing these cases can enhance understanding of post-infectious retinal immune responses and guide appropriate clinical management.