Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Birdshot Retinochoroidopathy (BRC)


History of Present Illness

A 53-year-old Caucasian male was referred to a tertiary uveitis care unit for chronic bilateral floaters and blurred vision in both eyes (OU). He noticed the floaters for the first time over a year ago but was not worried until his vision started to drop with concomitant distorted vision, 3 weeks before the consultation. His medical history includes tonsillectomy during childhood ( Figs. 37.1 to 37.3 ).

Exam
OD OS
Visual acuity 20/200 20/200
Intraocular pressure (IOP) 11 12
Sclera/conjunctiva Quiet Quiet
Cornea Clear Clear
Anterior chamber (AC) Deep and quiet Deep and quiet
Iris Unremarkable Unremarkable
Lens Opalescent Opalescent
Anterior vitreous Vitritis (1+) Vitritis (1+)

Fig. 37.1, (A and B) Fundus photographs (OD and OS) showing the presence of oval, white, and creamy chorioretinal dots (<{1/2} to {3/4} papillary diameter) at the level of the posterior pole, especially in the inferonasal peripapillary segment of the right fundus. Visualization of the fundus is mildly affected by vitritis.

Fig. 37.2, (A and B) Fluorescein angiograms (OD and OS) show the presence of mild papillitis, periphlebitis, and diffuse capillaropathy evocative of macular edema OD > OS. No macular atrophy or optic disc damage is suspected at this stage.

Fig. 37.3, (A and B) Indocyanine green angiograms (ICGA) (OD and OS) disclose the presence of presumably granulomatous lesions, corresponding to the white dots, in the form of hypofluorescent, round, black dots during the intermediate phase of the angiogram. Lesions are more numerous and extensive on ICGA compared with fundus photographs or fluorescein angiograms.

Questions to Ask

  • Did you ever experience redness or pain in your eyes?

He responded no.

  • Do you have any difficulty while driving in the dark or while performing any activities in dim light?

He responded yes.

  • Do you ever see any spontaneous or flashing lights?

He answered yes.

Assessment

Bilateral vitritis, retinochoroiditis, and periphlebitis with bilateral macular edema

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