Progressive confluent circumpapillary multiple evanescent white-dot syndrome

PURPOSE: To describe a morphologic variant of the multiple evanescent white -dot syndrome that, can mimic other conditions. METHODS: We examined three patients with severe cases of unilateral multipl e evanescent white-dot syndrome characterized by an atypical progressive ci rcumpapillary discoloration of the fundus. RESULTS: The confluent circumpapillary lesion progressed toward or beyond t he equator of the fundus, raising initial concern of a viral retinitis. How ever, pinpoint dots at the leading edge evolved into the typical wreath-lik e spots of multiple evanescent white-dot syndrome, which then coalesced int o the advancing edge of a geographic retinitis or retinal pigment epithelii tis, before spontaneous resolution. CONCLUSION: Progressive geographic circumpapillary discoloration, appearing as a giant white spot, occurs rarely in severe cases of multiple evanescen t white-dot syndrome. The distinctive appearance may suggest a disorder oth er than multiple evanescent white-dot syndrome, which can make initial diag nosis more difficult and lead to unnecessary or inappropriate resting and t reatment. (Am J Ophthalmol 1999;128:378-380. (C) 1999 by Elsevier Science I nc. All rights reserved.).