title: Ocular toxoplasmosis presenting with focal retinal nerve fiber atrophy simulating glaucoma.
abstract: OBJECTIVE
  We describe a patient with ocular hypertension and nonglaucomatous retinal nerve fiber layer (RNFL) atrophy associated with an ocular toxoplasmosis retinal lesion.
  
  
  METHODS
  Single case report.
  
  
  RESULTS
  An RNFL defect was identified adjacent to a circumscribed pigmented chorioretinal lesion superior to the macular region. The optic disc showed a prominent central cup without focal neural rim atrophy. Red-free photography and RNFL imaging using optical coherence tomography and scanning laser polarimetry showed corresponding focal RNFL atrophy. The toxoplasmosis lesion was characterized by an apparent full thickness disruption in retinal architecture, including the retinal ganglion cell layer, using spectral-domain optical coherence tomography.
  
  
  CONCLUSIONS
  Nonglaucomatous retinal lesions may simulate glaucomatous RNFL atrophy and visual field loss, particularly when focal damage to the retinal ganglion cells occurs. Careful inspection of the retina and optic disc, with attention to the integrity of the neural rim, and analysis of the pattern of RNFL loss in proximity to a retinal lesion may enable the clinician to differentiate glaucomatous and nonglaucomatous pathogenic mechanisms.
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Palm Beach Gardens, FL 33418, USA.
authors.forename: Clinton W
authors.initials: CW
authors.lastname: Sheets
authors.forename: Dilraj S
authors.initials: DS
authors.lastname: Grewal
authors.forename: David S
authors.initials: DS
authors.lastname: Greenfield
mesh_terms: D000328:Adult; D001284:Atrophy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D009412:Nerve Fibers / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology*; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014126:Toxoplasmosis, Ocular / Q000150:complications / Q000175:diagnosis*