Ocular Toxoplasmosis: Bridging Clinical Diagnosis and Evidence-Based Management

Abstract

Background: Ocular toxoplasmosis is one of the most common infectious causes of posterior uveitis and may lead to recurrent inflammation and visual impairment. It most often presents as necrotizing retinochoroiditis, but the clinical picture depends on lesion location and immune status.

Aim: This review summarizes current evidence on clinical manifestations, diagnosis and treatment of ocular toxoplasmosis.

Material and methods: A narrative review of PubMed and Scopus publications from 2002–2025 was performed, focusing on clinical presentation, diagnostic methods and therapeutic management.

Results: Ocular toxoplasmosis usually presents as focal retinochoroiditis with vitritis and, less commonly, anterior uveitis. Immunocompromised patients may develop bilateral, multifocal or extensive lesions. Diagnosis is primarily clinical and may be supported by serology, multimodal imaging, PCR testing and assessment of intraocular antibody production in uncertain cases. Conventional therapy with pyrimethamine, sulfadiazine and corticosteroids remains effective, while trimethoprim-sulfamethoxazole offers comparable efficacy with a more favorable safety profile. Intravitreal clindamycin with dexamethasone may be considered when systemic treatment is contraindicated.

Conclusions: Early diagnosis and individualized treatment are essential to reduce irreversible retinal damage. Current therapies control active inflammation but do not eradicate latent infection or reliably prevent recurrence.