Birdshot choroidopathy is a rare autoimmune uveitis characterized by yellow-white choroidal lesions clustered around the optic nerve and radiating towards the periphery, nearly always involving the inferior and nasal areas. It causes symptoms like nyctalopia, floaters, flashes of light, and dyschromatopsia. Diagnosis requires bilateral disease, ≥3 peripapillary lesions, vitreous cells and haze, and may include HLA-A29 positivity and retinal vasculitis. Investigations include fluorescein angiography, indocyanine green angiography, visual field testing, electroretinography, and optical coherence tomography. Acute flares are treated with oral or intravitreal st

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▪ What is (birdshot choroidopathy)? DR JOHN 2020
It is a Birdshot uveitis is characterized by: -
a) yellow-white choroidal lesions ¼ to ½ optic disc diameter.
b) clustered around the optic nerve and the posterior pole, radiating towards the periphery.
c) nearly always involving inferior and nasal peripapillary area.
d) It is a pattern similar to the gunshot spatter from birdshot
▪ Causes: -
Unknown ( autoimmune)
▪ Symptoms: -
1) Nyctalopia ( poor vision in dim / dark )
2) Floaters
3) Flashes of light (Photopsia)
4) Dyschromatopsia
▪ Diagnostic criteria:
An International Workshop held at UCLA in 2002 established a set of diagnostic criteria.
• Required Characteristics Included:
1) Disease in both eyes (bilateral)
2) ≥ 3 peripapillary birdshot lesions (cream-colored, irregular or elongated choroidal lesions with
long axis radiating from optic disc)
3) > 1+ anterior vitreous cells
4) > 2+ vitreous haze
• Supportive Findings:
1) HLA-A29 (+ve)
2) Retinal vasculitis
3) Cystoid Macular Oedema (CME)
▪ Investigations: -
1) FFA / (area of Hypoflurescence, doesn’t typically highlight spots)
2) ICG (areas of Hypoflurescence) , shows spots more numerous .
3) VF (scattered, arcuate scotoma, enlarged blind spot)
4) ERG (marked decreases of B waves – mullers and bipolar cells)
5) OCT ( decreases reflectivity of photoreceptors)

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▪ What is the most significant sign in FFA?
Early hypo – later Hyperflurescence.
▪ DD: (white dot syndrome)
1) TB
2) Syphilis
3) Sarcoidosis
4) Histoplasmosis
5) VKH
▪ Complications: - (TRIAD of Vitritis)
1. Cataract
2. CME
3. ERM (epiretinal membrane)
▪ Treatment: -
Acute flares: Steroids
1) Oral Steroids.
2) Intravitreal Triamcinolone implant— ↓ CME and maintained BCVA,
Side effects: -
but patients eventually require cataract surgery and / or anti glaucomatous medications (intraocular
pressure lowering).
Chronic disease: Immunomodulatory Therapy
1) Cyclosporine A (3mg/kg/day to 5mg/kg/day)
2) Methotrexate.

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