Birdshot Chorioretinopathy: The Rare Eye Disease That Leaves Cream-Colored "Shotgun Pellet" Spots — and Why Early Treatment Is Everything
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD. Last reviewed October 13, 2026. This content is for educational purposes and is not medical advice.
Quick Answer
Birdshot chorioretinopathy is a rare form of posterior uveitis that can cause permanent vision loss or blindness, usually in white adults ages 40–60 [1]. Cream- and orange-colored oval spots resembling birdshot appear in the retina [1]. Symptoms include floaters, blurred vision and night blindness. There is no cure, but corticosteroids and immunosuppressants protect vision [1].
What the research says
There is no single agreed-on treatment plan, and long-term control usually needs immune-calming medicine. A review of the published evidence found no consensus on the best treatment regimen or how long to treat. Local and systemic corticosteroids can be used for short periods, but immunosuppressive or biological therapies are usually needed for long-term management (Bousquet et al., J Clin Med, 2022) [5].
Stopping treatment can be followed by a late relapse. In a series of 55 patients, 20 (36.4%) had a late recurrence, and recurrences appeared within 30 months after successful treatment was stopped. The authors suggested that about 30 months of successful treatment may be ideal, and no patient or imaging feature predicted who would relapse. Never stop your medicine without your eye specialist's guidance (Maleki et al., Can J Ophthalmol, 2023) [6].
Some people respond to treatment better than others, and early eye scans may offer clues. In a series of 279 patients (180 responsive and 99 resistant to treatment), small-vessel leakage in the macula and leakage at the optic nerve head on the earliest scans may be risk factors for resistant disease (Maleki et al., Ocul Immunol Inflamm, 2023) [7].
What Is Birdshot Chorioretinopathy?
Birdshot chorioretinopathy (pronounced koor-ee-oh-reht-in-OHP-ah-thee) is a rare inflammatory eye disease that can lead to permanent vision changes or complete loss of sight [1]. It is a long-term (chronic) condition and a severe form of posterior uveitis — a group of diseases that damage eye tissue [1].
The disease attacks two layers at the back of your eye. The retina is the light-sensitive tissue that captures what you see, and the choroid is the layer that connects the retina to the sclera, the white part of the eye.
Eye care specialists can spot the hallmark signs on a dilated eye exam. They appear as cream- and orange-colored oval spots in the deep retina and the superficial (top layer) choroid. The spots resemble the pattern from birdshot — small shotgun pellets or bullets [1]. That is where the unusual name comes from.
The condition usually affects both eyes. It is rare — researchers believe it affects fewer than 1 in every 100,000 people worldwide [1]. You may also hear it called birdshot retinochoroidopathy, birdshot uveitis, or BSCR for short.
While there is no cure, birdshot chorioretinopathy is a treatable disease. Early detection is essential to the success of the treatment [1].
Key fact | Detail |
What it is | A severe form of posterior uveitis, an inflammatory eye disease |
Tissues damaged | Retina (light-sensitive back layer) and choroid (connects retina to sclera) |
Hallmark sign | Cream- and orange-colored oval spots, like tiny shotgun pellets |
Eyes affected | Usually both eyes |
How common | Fewer than 1 in 100,000 people worldwide |
Cure? | No cure, but treatable — early detection is key |
Other names | Birdshot retinochoroidopathy, birdshot uveitis, BSCR |
What Are the Symptoms of Birdshot Chorioretinopathy?
Birdshot symptoms can vary. The disease develops gradually, with symptoms that typically worsen over several months to years [1].
The first signs are often floaters — specks or strands that drift across your vision — or blurred vision. Unlike many other eye conditions, birdshot chorioretinopathy does not usually involve eye pain or redness [1].
Beyond the first signs, you may also experience:
Symptom | What it feels like |
Changing vision or vision loss | Sight that keeps shifting or fading |
Reduced side vision or depth judgment | Harder to see things to the side or judge how far away they are |
High eye pressure | Called ocular hypertension |
Night blindness | Called nyctalopia — trouble seeing in dim light |
Color vision problems | Trouble telling certain colors apart, called dyschromatopsia |
Light sensitivity | Discomfort in bright light or glare, called photophobia |
Some people notice unusual changes in their vision or perception. These may include the ceiling fan effect, when you close your eyes and see something like a ceiling fan or pinwheel whirring around. Others see flashing or flickering lights (photopsia) or distorted shapes (metamorphopsia), or experience shimmering, blurred, or hazy vision — like looking through water or dirty glass [1].
In severe cases, the condition can lead to cataracts (clouding of the eye's lens) or glaucoma (high eye pressure that damages the optic nerve). These can cause severe vision loss even after the inflammation itself is treated [1]. Birdshot uveitis may also cause problems in the central retina, including cystoid macular edema (swelling in the center of the retina) and epiretinal membranes (scar-like tissue on the retina's surface) [1].
One thing makes early detection tricky: it is possible to have the early stages of this condition and not even realize it. Symptoms do not always appear right away. The earliest signs may only be low levels of inflammation that only a provider can detect through a complete eye exam [1].
What Causes Birdshot Chorioretinopathy?
Researchers do not know the exact cause. They suspect it may be an autoimmune disease — when your body's immune system mistakenly attacks healthy tissues instead of protecting them [1].
Most people diagnosed with the condition inherit an antigen — a substance passed down from biological parents that can trigger an immune response — called HLA-A29. But inheriting this antigen does not guarantee you will get the disease. And though it is less common, you can develop birdshot chorioretinopathy even if you do not have HLA-A29 [1].
Who Is at Higher Risk?
Anyone can develop birdshot chorioretinopathy. However, a few patterns show up in the people who get it:
Risk factor | What the pattern shows |
Sex | Females may be slightly more likely to develop the condition |
Age | Most often affects people between 40 and 60 |
Ancestry | Most often affects white people |
Childhood | Rarely affects children |
How Is Birdshot Chorioretinopathy Diagnosed?
Diagnosis can be difficult. It is a rare disease, and its unique spots may not be visible in the early stages [1].
Eye care specialists — usually ophthalmologists, doctors who diagnose and treat eye diseases — most often diagnose BSCR with a dilated eye exam. They also use a blood test to confirm whether you carry the HLA-A29 antigen [1]. Several additional tests help diagnose and monitor the disease over time:
Test | What it does |
Eye exam (dilated) | Lets the specialist see the characteristic spots at the back of the eye |
Blood test | Confirms whether the HLA-A29 antigen is present |
Fluorescein angiography (FA) | An imaging test that shows the health of the blood vessels at the back of your eyes |
Indocyanine green (ICG) angiography | Uses an injected green dye to evaluate the health of the choroid |
Optical coherence tomography (OCT) | Takes pictures of your retina to look for swelling or nerve damage |
Electroretinogram | Checks your eyesight and how well your photoreceptors (rods and cones) are working |
Visual field test | Evaluates your entire field of vision, including central and peripheral vision |
Healthcare providers may use a combination of these tests to monitor you over time, so staying in touch with your provider matters.
How Is Birdshot Chorioretinopathy Treated?
Treatment depends on the severity of your condition and how it changes over time. The goal is to reduce swelling in your eyes and prevent or reverse vision loss [1].
Providers typically start with high doses of corticosteroids — powerful anti-inflammatory medicines — to control the inflammation [1]. Then they lower the dose as much as possible, because long-term use carries risks. Steroids can be delivered in several ways:
Delivery method | How it works |
Eye drops | Applied directly to the eye's surface |
Oral medicines | Taken by mouth as pills |
Intravitreal implant | An implant placed surgically inside the eye |
Injection | Injected near the eye |
IV | Given intravenously, through a vein |
Many people also need long-term treatment with immunosuppressants — drugs that stop the immune system from attacking the eyes. These may include alkylating agents, antimetabolite drugs, biologic agents, and T-cell transduction/calcineurin inhibitors [1].
Are There Side Effects From Treatment?
Long-term steroid and immunosuppressant use can cause serious side effects, including gastrointestinal or bone issues. They may also increase your risk of developing cataracts or glaucoma [1] [4].
Your healthcare provider will monitor you for side effects and prescribe other medications if you need them. If you are taking steroids by mouth, providers will check you for bone damage (osteoporosis) and fracture risk. You may also receive a bone density scan, and your provider may prescribe bisphosphonates — medication that helps prevent bone loss [1].
Can I Prevent Birdshot Chorioretinopathy?
Birdshot chorioretinopathy has no known means of prevention, but regular eye exams can help catch it early [1]. In most cases, researchers believe a specific antigen passed down in families triggers it — so prevention is not in your hands.
What you can do is catch it early. Regular eye exams can help detect early symptoms so you can receive timely treatment if needed. Tell your healthcare provider if any family members have eye disease [1].
What is the bottom line on birdshot chorioretinopathy?
Birdshot chorioretinopathy is a rare eye disease that paints shotgun-pellet-like spots across the retina and choroid of both eyes — usually in white adults between 40 and 60 [1]. It can damage vision permanently if it goes untreated, but it does not usually cause pain or redness, and early stages can be completely silent. That makes regular eye exams, floaters and blur you should never ignore, and fast treatment with steroids and immune-suppressing drugs the best defense. Most people can keep their vision stable with early, consistent care — and milder cases sometimes stay stable even without treatment [1].
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Frequently Asked Questions
What is birdshot chorioretinopathy?
It is a rare, chronic inflammatory eye disease — a severe form of posterior uveitis — that damages the retina and choroid and can lead to permanent vision loss or blindness. Its name comes from the cream- and orange-colored spots it leaves, which resemble birdshot, or small shotgun pellets.
Is birdshot chorioretinopathy curable?
No. There is no cure, but it is a treatable disease. Treatment reduces swelling in the eyes and can prevent or reverse vision loss, and early detection is essential to treatment success.
How common is birdshot chorioretinopathy?
It is very rare. Researchers believe it affects fewer than 1 in every 100,000 people worldwide.
Who is most likely to get birdshot chorioretinopathy?
It most often affects white people between the ages of 40 and 60. Females may be slightly more likely to develop it, and it rarely affects children.
What does birdshot chorioretinopathy look like inside the eye?
Eye specialists see cream- and orange-colored oval spots in the deep retina and the top layer of the choroid. The pattern resembles the spread of birdshot — small shotgun pellets — on a dilated eye exam.
Does birdshot chorioretinopathy cause eye pain or redness?
Usually not. It typically presents with floaters and blurred vision without eye pain or redness, which is one reason it can be missed.
What are the first symptoms of birdshot chorioretinopathy?
The first signs are often floaters or blurred vision. The disease develops gradually and symptoms typically worsen over months to years.
What is the ceiling fan effect in birdshot chorioretinopathy?
It is a perceptual symptom where, when you close your eyes, you see something like a ceiling fan or pinwheel whirring around.
What is HLA-A29?
HLA-A29 is an antigen — a molecule that triggers an immune response — that most people diagnosed with birdshot chorioretinopathy inherit from their biological parents. Carrying it does not guarantee the disease, and some people develop the condition without it.
Is birdshot chorioretinopathy an autoimmune disease?
Researchers suspect it may be, since autoimmune diseases occur when the body's immune system mistakenly attacks healthy tissues. The exact cause is still unknown.
How is birdshot chorioretinopathy diagnosed?
Most often with a dilated eye exam, plus a blood test to confirm the HLA-A29 antigen. Imaging tests such as fluorescein angiography, ICG angiography, OCT scans, electroretinograms, and visual field tests help confirm and monitor it.
What tests are used to monitor birdshot chorioretinopathy?
Providers may combine fluorescein angiography, ICG angiography, OCT, electroretinography, and visual field testing to watch the disease over time.
How is birdshot chorioretinopathy treated?
Treatment typically starts with high-dose corticosteroids — given as eye drops, oral medicines, an implant, an injection, or IV — then tapered to the lowest effective dose. Many people also need long-term immunosuppressants such as alkylating agents, antimetabolites, biologics, or T-cell inhibitors.
Can birdshot chorioretinopathy cause cataracts or glaucoma?
Yes. In severe cases it can lead to cataracts or glaucoma, which may cause severe vision loss even after the inflammation is treated. The disease can also affect the central retina, causing cystoid macular edema and epiretinal membranes.
Can I prevent birdshot chorioretinopathy?
There is no known way to prevent it, since it is usually triggered by an inherited antigen. Regular eye exams and telling your provider about any family history of eye disease are the best ways to catch it early.
Related Reading
Uveitis: Symptoms, Causes, and Treatment — What Eye Inflammation Means for Your Vision: the broader family of eye inflammation that birdshot belongs to.
Cystoid Macular Edema: What It Is, Symptoms, Causes, Diagnosis, Treatment and Outlook — What You Need to Know: the retinal swelling that birdshot can cause.
Glaucoma: The Silent Threat to Vision, and How Early Treatment Can Protect Your Sight: high eye pressure that can damage the optic nerve.
References
Cleveland Clinic. Birdshot Chorioretinopathy. Cleveland Clinic. Updated July 2, 2025. https://my.clevelandclinic.org/health/diseases/23024-birdshot-chorioretinopathy
American Academy of Ophthalmology. Birdshot Retinochoroidopathy. EyeWiki. Updated August 8, 2026. https://eyewiki.aao.org/Birdshot_Retinochoroidopathy
Bergstrom R, et al. Birdshot Retinopathy. StatPearls. Updated August 8, 2023. https://www.ncbi.nlm.nih.gov/books/NBK554416/
National Eye Institute. Uveitis. National Eye Institute. Accessed October 14, 2026. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/uveitis
Bousquet E, et al. Birdshot Chorioretinopathy: A Review. J Clin Med. 2022;11(16):4772. PMID 36013011. https://doi.org/10.3390/jcm11164772
Maleki A, et al. Late recurrence in birdshot chorioretinopathy. Can J Ophthalmol. 2023;58(2):77-81. PMID 34534507. https://doi.org/10.1016/j.jcjo.2021.08.006
Maleki A, et al. Birdshot Chorioretinopathy: Resistant versus Responsive. Ocul Immunol Inflamm. 2023;31(3):477-482. PMID 35353656. https://doi.org/10.1080/09273948.2022.2032193
Medical disclaimer
The information in this article is for general educational purposes only and is not intended as professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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