Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 7296
  • Home
  • Print this page
  • Email this page

   Table of Contents      
ARTICLES
Year : 1977  |  Volume : 25  |  Issue : 2  |  Page : 19-21

Quinine idiosyncracy leading to bilateral subhyaloid haemorrhage


Medical College and Hospital, Jaipur, India

Correspondence Address:
Mohan R Jain
Department of Ophthalmology, Saiwai Man Singh Medical College and Hospital, Jaipur
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 615145

Rights and PermissionsRights and Permissions

How to cite this article:
Jain MR, Mehta S. Quinine idiosyncracy leading to bilateral subhyaloid haemorrhage. Indian J Ophthalmol 1977;25:19-21

How to cite this URL:
Jain MR, Mehta S. Quinine idiosyncracy leading to bilateral subhyaloid haemorrhage. Indian J Ophthalmol [serial online] 1977 [cited 2020 May 31];25:19-21. Available from: http://www.ijo.in/text.asp?1977/25/2/19/31253

Since the first discovery of ocular toxicity of quinine by Giamini[6] in 1841, innumerable re­ports have appeared in the literature. A survey of the literature indicates that the effects have been rather uniform. In the mildest disturban­ces, symptoms consist of slight clouding or flickering of vision, noises in the ears, accom­panied by weakness, and confusion. In more severe cases there is sudden complete blindness, dizziness, tinnitus, partial deafness and, in ex­treme cases, there had been deep coma with circulatory collapse, followed by complete blind­ness which gradually recovered to a consider­able extent.[13]

Marked and permanent constriction of retinal arteries[12],[14] optic nerve atrophy[10],[11] retinal oedema leading to cherry red spot in the macula[5], ischaemic stromal atrophy of iris[9], E.R.G. changes[1],[4] and E.O.G. changes[2] have been described.

The case described below had the unique feature of developing bilateral subhyaloid haemorrhage after therapeutic dose of intramus­cular quinine hydrochloride injection, given for the treatment of malarial fever.


  Case Report Top


Mrs. R.D., a young lady of 23 years was admitted to the eye ward on 9th November 1974 with a complaint of sudden bilateral diminution of vision following two injections of quinine hydrochloride (200 mg each conse­cutive day) intragluteally.

Patient delivered a child about 70 days back. Delivery was normal except postpartum haemorr­hage leading to anaemia. While the patient was being treated with anti-anaemic drugs, she developed fever with chills and rigor which was diagnosed as malaria. Patient was injected quinine hydrochloride on left but­tock without any side effects. Next day, when the same injection was repeated on her other buttock, after 5-10 minutes of injection, she noticed a red vision in the left eye followed by red vision in the other eye after 10 minutes. Red vision persisted and there was consider­able loss of vision, but the patient had no other symp­tom of any kind. Patient came to us three months after this episode,

Examination : External examination revealed noth­ing abnormal except slightly dilated pupil which reacted well to light, Right eye vision was 6/60 and left eye 6/24, and with pinhole though the visual acuity remained same, the words became hazy, Tension was normal in both eyes.

Fundus examination ; Reflex in both eyes was good. Optic discs showed generalised pallor. Arteries were markedly constricted and at places could not be traced beyond equator. Veins appeared to be normal. There was a large central subhyaloid haemorrhage, involving the macular and paramacular area in both eyes. In the right eye the haemorrhage extended about 3 disc diame­ter horizontally and 1.5 disc diameter vertically. Dark stippling was present in the lower part of the haemorr­hagic area. Vitreous was perfectly healthy and showed no red blood cells or detachment.


  Investigations Top


Peripheral fields - both eyes showed7°,10° of concentric constric­tion of fields.

Central fields: - Showed central scotomas involving 10° to 12° sub of fields.

Blood: - Erythrocyte sedimenta­tion rate 10 mm first hour. Red blood cell count 2.5 million/cu. mm. Hb 7 gm%.

Urine - No sugar and no micro­scopic abnormality.

Bleeding and clotting time was normal.

Treatment: Case was treated with rest, local atropine, anti-anaemic drugs, vasodilators and injection of vitamin B 1 and B 1,2 .

Progress of the condition was very slow and within 20 days of treatment patient improved her vision to 6/36 in the right eye and 6/9 in the left. In both eyes, the area of haemorrhage decreased by one-third and the colour of blood appeared more faint and gave a more stippling appearance. Foveal reflex was absent and macular area could not be distinctly demarca­ted.


  Discussion Top


Ocular involvement due to quinine is mostly be due to idiosyncrasy of the drug, since the incidence of ocular complications is very small in comparison with the extent to which this compound has been employed in medicine.[14] Retinal haemorrhages due to qui­nine toxicity have never been reported earlier, though quinine is known to cause severe arterial spasm which may cause slowing of blood stream and venous thrombosis, consequently leading to minute haemorrhages.

Goodman and Gillman[7] stated that acute haemolytic reactions to quinine may rarely oc­cur in malarial patients and pregnant woman. Animal experiments have produced some evi­dence of endarteritis and periarteritis[12] and a direct effect on the cell membrane has been suggested by Bennet and Desforges[3] leading to haemolysis.

Since the subhyaloid haemorrhage is mostly derived from small venules, we presume that there was already some degree of venous dilata­tion and stagnation of blood due to anaemia. Idiosyncrasy to quinine caused severe arterial spasm, with further dilatation and stagnation of blood in venules leading to haemorrhage. Haemolytic eflect of quinine might have been additional contributing factor in increasing the haemorrhage.


  Summary Top


A most unusual case of quinine idiosyncrasy in a 23 year old female anaemic patient is described. Only after two consecutive intraglu­teal injections of quinine hydrochloride, patient developed bilateral subhyaloid haemorrhage which persisted for a long period.

 
  References Top

1.
Bard,L A., and Gilis,J.P. 1964, Arch. Ophth. 72, 328.  Back to cited text no. 1
    
2.
Behrman.J., Mushin. A. 1968, Brit. J. Oph­thal., 52, 12,925.  Back to cited text no. 2
    
3.
Bennet, J.M., and Desforges, J.F., 1967, Brit. J. Haemat., 13, 706.  Back to cited text no. 3
    
4.
Chabot,J., Verin,P., Bouchard,J., 1963, Bull. Soc. Ophthal. France, 63, 351.  Back to cited text no. 4
    
5.
Duggan,J.N., and Nanawati,B.P., 1931, Brit-Jour Ophthal., 15, 160.  Back to cited text no. 5
    
6.
Giamini,A., Cited by Welsh F.B. and Hoyt W.F. 1969, Clinical neuro-opthal. Ed. 3, 2553.  Back to cited text no. 6
    
7.
Goodman, L.S. and Gillman,A. 1974, The phar­macologic basis of therapeutics, Ed, 4, 1115.  Back to cited text no. 7
    
8.
Hommer, K., Ulrich, W.D. and Woudsch, L., 1968, Graef. Arch. Klin. Exp. Ophthal. 175,2,121.  Back to cited text no. 8
    
9.
Knox, D.L.; Palmer,C.A.L. and English F., 1966, Arch.Ophthal.76, 3, 359.  Back to cited text no. 9
    
10.
Mckinna,A.J. 1966, Canada.Jour.Ophthal., 1, 261.  Back to cited text no. 10
    
11.
Michigan.J., 196'.. Med. Soc. 60,612.  Back to cited text no. 11
    
12.
Morton,G.W., Toxicology of thee yes 2nd ed pp. 870-876. Charles C. Thomas, U.S.A., 1974.  Back to cited text no. 12
    
13.
Otradovec, J., 1973, Oftal. 29,4, 295.  Back to cited text no. 13
    
14.
Sorsby,A., 1972, Modern Ophthalmology. 2, 677, Butterworth, London.  Back to cited text no. 14
    


    Figures

  [Figure - 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Case Report
Investigations
Discussion
Summary
References
Article Figures

 Article Access Statistics
    Viewed1761    
    Printed44    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal