Abstract
Ocular toxoplasmosis remains to be the most common cause of infectious uveitis in immunocompetent individuals with highly variable prognosis. The transmission mode can be either congenital or acquired. A precise diagnosis of the disease is necessary to opt effective and rapid treatment. While ocular toxoplasmosis usually presents in the classic form, it may as well present in variable clinical spectrum. The diagnosis can be suspected by the ocular inflammatory clinical presentation as well as multimodal imaging. However, serologic tests including intraocular fluid testing may be needed. Treatment includes combination of systemic antiparasitic and anti-inflammatory drugs with variable effectivity. More recently, intravitreally antimicrobials may be used. The chapter aims to layout the different clinical presentations and complications of ocular toxoplasmosis. Diagnostic techniques and different antimicrobial combinations for treatment will also be discussed.
Highlights
Ocular toxoplasmosis is one of the most common cause of posterior uveitis caused by an intracellular parasite, toxoplasma gondii [2, 3]
Ouyang et al reported that 7.5% of the cases presented with Cystoid macular oedema (CME), while 2.5% presented with a huge outer retinal cyst (HORC)
As the retinitis starts to heal, the Optical coherence tomography (OCT) scans show the hyperreflective area of retinitis, within the neurosensory retina starts to decrease in thickness with regressing of any adjacent Subretinal fluid accumulation (SRF) or CME
Summary
25 to 30% of the world’s human population is infected by toxoplasma [1]. Ocular toxoplasmosis is one of the most common cause of posterior uveitis caused by an intracellular parasite, toxoplasma gondii [2, 3]. 1952, Helenor Campbell Wilder (later Helenor Campbell Wilder Foerster) confirmed the growing suspicion that toxoplasma gondii was a cause of uveitis in otherwise healthy adults by identifying the presence of both trophozoites and brachyzoites in enucleated eyes, that suffered severe intraocular inflammation [4]. Factors that may influence visual prognosis include severity of the inflammation, size of the lesion and site of the inflammation. Laboratory testing of intraocular fluid has been widely studied and employed, including PCR testing and detection of intraocular antibodies using Goldmann-Witmer coefficient (GWC), to enable more precise diagnosis Ocular toxoplasmosis has a self-limiting nature, treatment can help rapid control of inflammation specially if the retinitis involves the posterior pole. Infectious Eye Diseases - Recent Advances in Diagnosis and Treatment recurrences, but some combinations have shown more effective reduction in the size of the retinal lesion in comparison to other combinations or no treatment [5]
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