Background <p>Multiple evanescent white dot syndrome (MEWDS) is a rare transient inflammatory retinopathy characterized by discrete white dots disseminated on the fundus. Focal scleral nodule (FSN) typically presents as a stable, solitary, yellow-white, subretinal lesion arising from the sclera. This article reports a rare case of MEWDS associated with FSN in a young female.</p> Case presentation <p>A 34-year-old female presented with a complaint of gradually enlarging paracentral scotomas in the left eye for 8 days. At presentation, best-corrected visual acuity (BCVA) was 20/25 in the left eye. Fundus examination of the left eye revealed optic disc edema and an orange-yellow irregular lesion on the infratemporal side of the fovea. The multimodal imaging (MMI) findings revealed a rather typical MEWDS-like reaction and a subretinal lesion located at the sclera. After thorough consideration, the patient was diagnosed with MEWDS associated with FSN. Corticosteroid therapy was then administered to the patient. After 11 weeks, her BCVA recovered to 20/20 in the left eye, and the visual field defect had improved. Additionally, the MEWDS-like reaction had significantly recovered. The FSN remained stable during the 18-month follow-up.</p> Conclusions <p>This is the first reported case of MEWDS associated with FSN, expanding the understanding of both conditions.</p>