Multiple Evanescent White Dot Syndrome Following Adenovirus Vector-Based COVID-19 Vaccine (Covishield).

PURPOSE: To report a case of multiple evanescent white dot syndrome (MEWDS) following adenovirus vector-based Coronavirus disease 2019 (COVID-19) vaccine, Covishield and to present a summary of previously reported cases of MEWDS following COVID-19 vaccines. METHODS: Retrospective case report and review of literature. RESULTS: A 22-year-old Indian female presented with blurred vision, scotomata, and photopsias in her left eye, a day after administration of second dose of Covishield vaccine. Her clinical findings and imaging features confirmed the diagnosis of MEWDS. Her symptoms resolved spontaneously after 2 weeks. CONCLUSION: This is the first reported case of MEWDS following an adenovirus vector-based COVID-19 vaccine. Comparison with previously reported cases of MEWDS following COVID-19 vaccination showed that patients are generally healthy, young to middle-aged women, who develop symptoms after a median time of one week and recover spontaneously over a median period of 4 weeks.

Recurrent Multiple Evanescent White Dot Syndrome (MEWDS) Following First Dose and Booster of the mRNA-1273 COVID-19 Vaccine: Case Report and Review of Literature.

To report a rare case of a patient with two recurrent episodes of Multiple Evanescent White Dot Syndrome (MEWDS) associated with the second dose and second booster of the mRNA-1273 COVID-19 vaccine (Moderna), and to perform a literature review on COVID-19-vaccine-associated MEWDS. Case Report: A 31-year-old female was evaluated for a temporal scotoma and photopsias that started two weeks after the second dose of the Moderna COVID-19 vaccine. Dilated fundus findings were remarkable for unilateral, small whitish-yellow dots scattered around posterior pole of the left eye, consistent with a diagnosis of MEWDS. The symptoms resolved three months later without treatment. Approximately one year after the first vaccine, the patient received the second Moderna COVID-19 vaccine booster and experienced a recurrence of symptoms with an enlarged scotoma and similar examination findings. The patient was treated with a course of systemic corticosteroids with subsequent clinical improvement. Conclusion: Although uveitis following COVID-19 vaccines is rare, our case highlights a need for increased awareness amongst practitioners regarding COVID-19-vaccine-associated onset or recurrence of ocular inflammatory diseases.

Multiple evanescent white dot syndrome following SARS-CoV-2 infection - A case report.

To report a case of MEWDS post-COVID-19 infection with multimodal imaging. A 17-year-old boy reported blurring of vision in both eyes 2 months and 10 days following the SARS-CoV-2 infection. Fundus examination revealed hypopigmented lesions nasal to the optic disc, inferior periphery, and near macula in both eyes. Multimodal imaging was consistent with MEWDS. A complete systemic workup was performed to exclude infectious etiology. Fundus lesions resolved with a course of oral corticosteroids and was confirmed on multimodal imaging.

Uveomeningeal syndrome presenting with bilateral optic disc edema and multiple evanescent white dots syndrome (MEWDS).

Purpose: To report a uveomeningeal syndrome with bilateral optic disc edema and a MEWDS-like presentation. Observations: A 17-year-old female experienced daily fevers for 3 days (ranging from 101.4 F to 102 F), then received the first dose of the Pfizer SARS-CoV-2 vaccine nearly three weeks later. Within two days she experienced severe headaches with severity scale of 8/10. Retinal imaging at the time showed optic disc edema in both eyes (OU) and multifocal well-circumscribed chorioretinal white lesions in the periphery OU. Neuroimaging and routine infectious and inflammatory laboratory testing were normal. Lumbar puncture showed elevated opening pressure and cerebrospinal pleocytosis consistent with an aseptic meningitis. At follow up, one month later the symptoms and retinal findings resolved. Conclusions: MEWDS is typically an idiopathic condition but can occur in the setting of viral illness. Although other white dot syndromes have been associated with uveomeningeal presentations, to our knowledge this is the first such case to be described in the English language ophthalmic literature.

Multiple evanescent white dot syndrome following BNT162b2 mRNA COVID-19 vaccination.

Purpose: To report a case with multiple evanescent white dot syndrome (MEWDS) following BNT162b2 mRNA COVID-19 vaccination. Observations: Case: A 67-year-old Japanese female presented with central visual field loss and photopsia in the right eye (OD) for 5 days. She was complaining blurred vision with bright spots in vision in OD, but denied any ocular symptoms in left eye (OS). She had received the second dose of BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) one day before the onset of visual symptoms; flu-like symptoms such as mild fever and general fatigue also developed along with ocular symptoms such as decreased vision and hypersensitivity to light in OD following the second COVID-19 vaccine. The first dose of vaccine was administrated followed three weeks later by the second dose and was not associated with any ocular or systemic symptoms besides mild pain at the injection site. She had not been followed by any ophthalmologist before the initial visit. At the initial visit, best corrected visual acuity (BCVA) in decimal points was 0.2 in OD and 1.0 in OS. Ophthalmic examination showed multifocal white dots in the posterior retina with moderate vitritis (1+ haze and 2+ cells) in OD. Multimodal imaging in OD showed diffuse disruption of ellipsoid zone with variable punctate hyperreflective lesions at macula on optical coherence tomography, punctate hyperfluorescence in a wreath-like pattern and late staining on fluorescein angiography, and multiple hypofluorescent spots of various sizes in the late phases on indocyanine green angiography. Both multiple hypofluorescent spots and scattered hyperfluorescent spots corresponding to white dots in OD were also seen on fundus autofluorescence. Her laboratory and systemic evaluations were negative for syphilis, tuberculosis, or toxoplasma, and selected autoimmune diseases like sarcoidosis, Behcet's disease, rheumatoid arthritis, and systemic lupus erythematosus. No active intraocular inflammation or abnormality were seen in OS. One week later, the multifocal white dots disappeared in OD, and were almost invisible on fundus photography. At that time, multifocal electroretinogram showed decreased response with low amplitude density across the entire field in OD. The BCVA in OD spontaneously improved to 0.8 without any treatment. Collectively, these clinical course and findings were suggestive of a diagnosis of MEWDS after mRNA COVID-19 vaccination. Conclusions and importance: In this present case, BNT162b2 mRNA COVID-19 vaccination might have been associated with MEWDS-like entity with vision loss. It is important for physicians to monitor the ocular status carefully in patients with visual disturbance after COVID-19 vaccination.

Multiple Evanescent White Dot Syndrome following COVID-19 mRNA Vaccination in Two Patients.

PURPOSE: To describe two cases of multiple evanescent white dot syndrome (MEWDS) occurring after administration of COVID-19 vaccine. STUDY DESIGN: Case Report. RESULTS: Two patients presented soon after receiving their second-dose of the BNT162b2 Pfizer-BioNTech COVID-19 vaccine with findings consistent with MEWDS. Due to the significant reduction in vision, patients were treated with a short dose of oral corticosteroids. Both had complete resolution of their symptoms, visual acuity and retinal findings. CONCLUSIONS: The onset of inflammatory ocular adverse events following COVID-19 vaccinations suggest a maladaptive inflammatory response triggered by the vaccine. Onset of symptoms after COVID-19 vaccinations should prompt the ophthalmologist to assess for these rare adverse events. Despite the extremely rare occurrences of ocular adverse events, we unequivocally recommend that patients receive the full vaccine due to the vast benefit for both individuals and society that far outweighs the inconsiderable risk of harm.

Presumed Recurrent MEWDS following Covid-19 Vaccination.

PURPOSE: To present an unusual case of recurrent multiple evanescent white dot syndrome (MEWDS) following the coronavirus 2019 (Covid-19) vaccination. METHODS: Review of the clinical, laboratory, photographic, and angiographic records of a patient with MEWDS. RESULTS: A 49-year-old female who had MEWDS nine years ago presented to our clinic with blurred vision in her left eye. These symptoms occurred 2 days following Covid-19 vaccination. Fundus examinations and diagnostic testing were consistent with recurrent MEWDS. CONCLUSION: While rare, MEWDS can reoccur following Covid-19 vaccination.

An uncommon cold of the retina.

A 39-year-old woman with progressive loss of vision left eye was referred for evaluation. Notably, she had been diagnosed with COVID-19 two weeks beforehand. Examination and ancillary testing confirmed atypical multifocal evanescent white dot syndrome. Possible other masquerades were excluded. A few weeks later, visual acuity improved in the left eye and symptoms resolved together with normalization of ancillary testing, including visual fields.