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The right eye was unremarkable. Twelve days after the initial presentation, the patient requested to be seen emergently due to a sudden change in vision. The APD in the left eye had progressed to 0. Amsler grid showed a defect in the temporal half of the left eye and a HVF SITA Fast disclosed a generalized, relative, deep scotoma centered on the blind spot in the left eye Fig. The visual field of the right eye had low test reliability, but showed no significant defects. A repeat OCT demonstrated persistent subretinal fluid in the papillomacular bundle of the left eye, while the right eye remained unremarkable Fig. The patient was admitted to the hospital for observation.

Soon thereafter, testing revealed T. The patient was given a five-day course of pyrimethamine, sulfadiazine, leucovorin calcium, methylprednisolone succinate, valacyclovir, and pantoprazole. The patient was referred to the Center for Disease Control for evaluation of long-term antibiotic treatment. The patient was last seen for a scheduled follow-up evaluation four months after the initial onset. There was significant reduction in the optic nerve edema of the left eye, resolution of the pre-retinal and retinal hemorrhages, with mild residual retinal scarring Figs.

Humphrey visual fields demonstrated improvement in the left eye compared to prior testing 52 Clinical and Refractive Optometry Initial findings of what may have progressed to a necrotic and non-resolving neuro-retinitis secondary to a T. Clinicians often diagnose Fig. It has been reported that deep retinal lesions i. Patients treated with pyrimethamine should also receive folinic acid leucovorin calcium to minimize bone marrow suppression. A viable and potentially safer option for patients who cannot tolerate systemic therapy, is a combination of clindamycin and dexamethasone given as an intravitreal injection.

Fortunately, early diagnosis and intervention led to a good visual prognosis.

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