The retinal pigment epithelium (RPE) and the choriocapillaris are affected early in the retinopathy associated with long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency. RPE in culture possesses the machinery needed for mitochondrial fatty acid -oxidation in vitro. To further elucidate pathogenesis of LCHAD retinopathy, we performed immunohistochemistry of the human eye and brain with antibodies to -oxidation enzymes. Human eye and brain sections were stained with antibodies to medium-chain (MCAD) and very long-chain acyl-CoA dehydrogenase (VLCAD), short-chain 3-hydroxyacyl-CoA dehydrogenase (SCHAD), and mitochondrial trifunctional protein (MTP) harboring LCHAD. Antibodies to 2-methyl-3-hydroxybutyrylCoA dehydrogenase (MHBD) and cytochrome c oxidase subunit I (COX I) were used as a reference. VLCAD, MTP, MCAD, SCHAD, MHBD, and COX I antibodies labeled most retinal layers and tissues of the human eye actively involved in oxidative metabolism (extraocular and intraocular muscle, the RPE, the corneal endothelium, and the ciliary epithelium). MTP and COX I antibodies labeled the inner segments of photoreceptors. The choriocapillaris was labeled only with SCHAD and MCAD antibodies. In the brain, the choroid plexus and nuclei of the brain stem were most intensely labeled with -oxidation antibodies, whereas COX I antibodies strongly labeled neurons in several regions of the brain. Mitochondrial fatty acid -oxidation likely plays a role in ocular energy production in vivo. The RPE rather than the choriocapillaris could be the critical affected cell layer in LCHAD retinopathy. Reduced energy generation in the choroid plexus may contribute to the cerebral edema observed in patients with -oxidation defects. Mitochondrial fatty acid -oxidation is the major energyproducing pathway in several human tissues, especially in cardiac and skeletal muscle and the kidney. The liver converts acetyl-CoA formed by -oxidation to ketone bodies, acetoacetate, and -hydroxybutyrate. Although the brain and eye mostly rely on glucose oxidation (1), during prolonged fasting, the brain is capable of utilizing ketone bodies (2).Defects of mitochondrial fatty acid -oxidation are an important group of inherited metabolic disorders that present in infancy or childhood with life-threatening metabolic crises. In only one of these disorders, long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD; EC 1.1.1.211) deficiency, progressive pigmentary retinopathy occurs and is a major complication potentially leading to blindness (3). The retinopathy begins in infancy with pigment dispersion and degeneration of the retinal pigment epithelium (RPE), followed by circumscribed retinal atrophy with relative sparing of the peripheral fundus (3-6).