Bilateral multiple evanescent white dot syndrome documented and followed by swept-source OCT angiography: a case report

Bilateral Multiple Evanescent White Dot Syndrome (MEWDS) is rare and may mimic other Primary Inflammatory Choriocapillaropathies (PICCPs) such as Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE). Swept-source optical coherence tomography angiography (SS-OCTA) offers improved visualization of the choriocapillaris and may facilitate early differential diagnosis. A healthy 32-year-old man presented with acute bilateral visual field disturbances and central vision loss in the left eye. Multimodal imaging, including SS-OCTA, demonstrated outer retinal layer attenuation and mild choriocapillaris flow deficit in the right eye, with no flow deficit in the left eye. The findings were more consistent with MEWDS than with APMPPE. Serial follow-up revealed spontaneous recovery of best-corrected visual acuity (BCVA) to 20/16 in both eyes, accompanied by normalization of all imaging parameters. This case highlights the diagnostic importance of multimodal imaging, particularly SS-OCTA, in atypical presentations of MEWDS. Early and accurate identification helps avoid unnecessary treatment and prompts appropriate investigation when more serious pathology is suspected.