Birdshot Chorioretinopathy

Birdshot chorioretinopathy is also known as birdshot uveitis, it is a rare form of posterior uveitis. Uveitis is an inflammation of the uvea, which is the part of the eyes that provides the retina with most of its blood supply. The retina is at the back of the eyes and is a light-sensitive layer of cells that allow you to see or gives you your vision. Birdshot chorioretinopathy affects the uvea and the retina.

A classic sign of birdshot chorioretinopathy, are scattered painless light cream or orange oval shaped coloured spots that develop on the retina giving the distinctive appearance of a ‘birdshot pattern’.

Birdshot chorioretinopathy is more common in

• Caucasians

• 40-60 year olds but can affect people that are younger

• Female > male

Birdshot often starts with floaters and/or blurred vision.

Other symptoms that can be experienced and can vary from person to person are:

Night blindness

Pain

Glare

Photophobia – sensitivity to bright lights

Problems with colour vision

Flashing lights

Distortions in vision

Loss of depth perception

Loss of peripheral vision

Birdshot Chorioretinopathy is thought to be an autoimmune disease, where the person’s own immune system begins to attack its own tissues within the body.

There is on-going research to find the trigger for this condition and how the immune system is responsible. There is also research on how to develop new and better treatment regimes for the condition.

Usually patients with birdshot chorioretinopathy are treated with high levels of steroids to get the inflammation under control. The dosage is then tapered down to the lowest amount possible. Some patients will also require a long-term immunosuppressant to help stop the immune system from attacking their eyes.

Unfortunately, long-term steroid and immunosuppressant use can have side effects like weakening of the bones, stomach complaints, bruising of the skin and cataracts, so patients are closely monitored and may receive other medications to manage these side effects. These could include Vitamin D and calcium supplements. Cataracts in the eyes can be treated with cataract surgery.

Newer medications such as biologics that target specific parts of the immune system can also be used as part of a long-term treatment plan.

Currently there is no single treatment regimen that suits all people with birdshot chorioretinopathy; the treatment plan is usually tailored to the individual person. Most patients will experience flare-ups of inflammation; uncontrolled flare-ups can lead to further complications in the eyes.