En face optical coherence tomography of multiple evanescent white dot syndrome

Purpose: To report novel en face imaging findings of multiple evanescent white dot syndrome. Methods: A 25-year-old woman presented with photopsia and vision loss affecting the left eye. Ophthalmic examination, color fundus photography, fluorescein angiography, spectral domain optical coherence tomography (SD-OCT), fundus autofluorescence, en face OCT, and OCT angiography were performed. Results: The diagnosis of multiple evanescent white dot syndrome was made based on clinical examination and multimodal imaging findings. Fundus autofluorescence demonstrated numerous hyperautofluorescent spots that corresponded to multifocal areas of ellipsoid loss with SD-OCT. En face OCT illustrated multiple small round hyperreflective "dots" at the level of the outer nuclear layer that precisely colocalized over numerous hyporeflective "spots" at the level of the ellipsoid zone. Optical coherence tomography angiography demonstrated normal flow within the superficial and deep retinal capillary plexus and the choroid in the left eye. Conclusion: We report the unique en face OCT pattern of hyperreflective dots (at the level of the outer nuclear layer) that precisely colocalized over larger hyporeflective spots (at the level of the ellipsoid zone) in multiple evanescent white dot syndrome. This finding may provide a signature pattern of recognition for this elusive disorder.