Which presentation best describes ocular toxoplasmosis?

• A. Bilateral diffuse retinitis with minimal vitritis
• B. Unilateral focal retinitis with dense vitritis
• C. Painless white dot lesions scattered
• D. Severe retinal detachment with exudates

Answer: (B)

Ocular toxoplasmosis classically presents as a unilateral focal retinitis with dense overlying vitritis. In reactivation, a single localized necrotizing retinochoroidal lesion forms, while inflammatory cells fill the vitreous, often creating a hazy view of the retina—the classic “headlight in the fog.” This combination—one eye affected, a focal white retinal lesion, and prominent vitreous inflammation—is the hallmark finding. Other patterns like bilateral diffuse retinitis with little vitritis, scattered painless white dots, or severe retinal detachment with exudates are not typical presentations of toxoplasmosis and point toward different conditions or more advanced complications.