Birdshot Chorioretinopathy: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats birdshot chorioretinopathy?
An ophthalmologist (eye doctor) usually manages birdshot chorioretinopathy, a rare condition that causes inflammation deep inside the eye and can blur vision over time. A rheumatologist often helps too, since the immune system plays a role, and a primary care doctor can coordinate care between specialists. Call 911 for sudden vision loss or sudden, severe eye pain.
What is birdshot chorioretinopathy?
Birdshot chorioretinopathy is a rare eye condition. Painless, light-colored spots form on the retina, the layer at the back of the eye that senses light. The spots are small and pale. They sit deep inside the eye. The spots are scattered in a pattern that looks like the spots on a bird's feathers, which gives the condition its name. Doctors call it a type of posterior uveitis, which means inflammation deep inside the eye.
The condition is chronic, which means it lasts a long time, and it slowly gets worse in most patients. It is rare, but it can be treated. Doctors can watch it over time. Vision effects vary a lot from person to person. Some people's vision is only mildly affected, while others have a big drop in vision. It often starts in middle age. It is more common in women and in people of North European descent.
Symptoms
Common symptoms of birdshot chorioretinopathy are:
- Blurred vision that often gets slowly worse.
- Floaters, small specks that seem to drift across your line of sight.
- Night blindness, which means trouble seeing in dim light or at night.
- Flashes of light, also called photopsia.
- Blind spots or small areas of reduced vision, also called scotomas.
- Poor color and contrast sensitivity, so colors look washed out.
Symptoms may start in adulthood or later life. Some people have mild changes for years, while the disease slowly gets worse in most patients. About 2 in 10 patients get a milder form that goes into remission on its own. Ongoing inflammation can cause swelling in the macula, the part of the retina used for sharp central vision. In severe cases it can cause lasting vision loss.
Regular checkups help doctors catch these problems early.
Causes and who gets it
The exact cause is unknown. Doctors suspect it is an autoimmune disease, which means the immune system attacks the body's own tissue by mistake. In this condition, the immune system seems to target the choroid and retina, two layers at the back of the eye. A protein called HLA-A29 is found in more than 95 percent of patients. That is much more often than in the general population. Even so, the disease is not heritable, meaning it does not usually pass from parent to child.
How doctors diagnose it
An ophthalmologist diagnoses birdshot chorioretinopathy with a dilated eye exam. Dilating drops widen the pupil so the doctor can see the retina. The doctor looks for the small, cream-colored spots at the back of the eye. Tests that help include:
- Funduscopy, an exam of the back of the eye with a bright light and a lens.
- Fluorescein angiography, which uses a dye. The dye shows blood flow and swelling in the retina.
- Electroretinography (ERG), a test that measures how the retina reacts to light.
- Visual field testing, which maps blind spots and loss of side vision.
- A blood test for HLA-A29, which supports the diagnosis but does not confirm it on its own.
Treatment
Treatment aims to calm the inflammation and protect vision. Corticosteroid medicines can help in the short term. They may be given as eye drops, as shots around or into the eye, or as pills. Steroids do not work well for every patient over the long run. So doctors often add other medicines early. These steroid-sparing medicines calm the immune system. They include cyclosporine, methotrexate, mycophenolate mofetil, azathioprine, and tacrolimus. If the disease still does not respond, biologic medicines such as infliximab have helped some patients.
When to see a doctor
See an eye doctor soon if you have blurred vision, new floaters, flashes of light, or blind spots. Call 911 for sudden vision loss or sudden, severe eye pain. Ongoing inflammation can damage the optic nerve, the cable that carries signals from the eye to the brain. That damage can cause permanent vision loss, so early treatment matters.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. For this rare condition, such a doctor can refer you to an ophthalmologist, help coordinate care between your eye doctor and other specialists, and support your overall health during long-term treatment.
Common questions
What are the symptoms of birdshot chorioretinopathy?
Birdshot chorioretinopathy can cause blurry vision, floaters, poor night vision and trouble seeing colors clearly. Symptoms often affect both eyes and can slowly get worse without treatment. An eye doctor can look for small pale spots that give this condition its name.
Can a direct primary care doctor manage birdshot chorioretinopathy?
A direct primary care doctor cannot diagnose or treat birdshot chorioretinopathy alone, since it needs a detailed eye exam by an ophthalmologist. The primary care doctor can help by referring you quickly, coordinating with a rheumatologist, and supporting your overall health during treatment.
Is birdshot chorioretinopathy an autoimmune disease?
Yes, doctors believe birdshot chorioretinopathy happens when the immune system mistakenly attacks tissue inside the eye. This is why a rheumatologist, who treats immune system conditions, often works together with an ophthalmologist to manage treatment and monitor the immune system over time.
Sources
- NIH Genetic and Rare Diseases Information Center (GARD) - Birdshot chorioretinopathy
- Orphanet - Birdshot chorioretinopathy
- National Organization for Rare Disorders (NORD) - Birdshot chorioretinopathy
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
