Unilateral congenital ocular toxoplasmosis

Abstract

We report the case of a three-year-old child, who was brought back to the eye clinic by his parents for a strabismus affecting his left eye since the age of three months. The visual acuity of this eye was less than 20/60 at Snellen Chart, and 30/60 on the right eye. Fundus examination of the left eye, revealed a macular pigmented scar, and a nasal pigmented scar measuring two papillary diameters, associated with a papillary attachment membrane, and no scar in the right eye. Eye toxoplasmosis, that results from infection with the parasite toxoplasma gondii, is the most frequent cause of infectious retinochoroiditis; its diagnosis is based on the discovery, of an evocative lesion at the fundus, either active (whitish, oedematous) or scarring (pigmented or atrophic). The eye is an organ of high tropism of toxoplasmosis, which can be either congenital (transmitted from the mother to the fetus across the placenta during pregnancy) or acquired(eating contaminated foods), and whose evolution is characterized by flares and recurrences, making it potentially blinding. Its management is based on prevention, especially in pregnant not immune women, who must avoid cats and any telluric contact. When a congenital infection is detected, routine pre- and postnatal treatment is prescribed. The first-line treatment is based on pyrimethanamine-sulfadiazine, or trimethoprim-sulfamethoxazole, as well as corticosteroid therapy, which has the essential goal of reducing peri-lesional edema. The prognosis of ocular toxoplasmosis depends on the location of lesions, severe in the case of macular damage, and generally favorable in the case of peripheral damage.

Keywords

• toxoplasmosis
• congenital
• retinochoroiditis