Birdshot chorioretinopathy is a rare, chronic, bilateral posterior uveitis strongly associated with HLA-A29. It causes characteristic cream-coloured lesions and progressive visual disturbance.
Clinical features
The condition typically presents in middle age.
- Floaters, blurred vision, night vision problems, and photopsia
- Multiple oval, hypopigmented choroidal spots radiating from the optic disc
- Retinal vasculitis, macular oedema, and mild vitritis
- Very strong association with HLA-A29 on blood testing
Treatment
Long-term immunosuppression is often required to control inflammation.
- Systemic steroids initially, followed by steroid-sparing agents such as mycophenolate or cyclosporine
- Biologic therapies in resistant cases
- OCT and electroretinography to monitor macular and global retinal function
- Regular follow-up to balance disease control with medication side effects
