|Year : 1972 | Volume
| Issue : 4 | Page : 187-188
Department of Ophthalmology, Government Hospital, Masulipatnam, (A.P.), India
C M Sarma
Department of Ophthalmology, Government Hospital, Masulipatnam, (A.P.)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sarma C M. Quinine amblyopia. Indian J Ophthalmol 1972;20:187-8
Quinine amblyopia is characterised by sudden onset and complete amaurosis, with a tendency to recovery of central vision first, followed by slow recovery of peripheral vision, although in all, but the mildest cases, some permanent defect remains. (Duke Elder-1940).
Quinine causes visual disturbance on an idiosyncratic basis (Arnold Sorsby-1963). The onset often follows a single dose, either small or large.
Dilated and immobile pupils, pallor of the optic disc, extreme contraction of retinal vessels, red spot at the macula generalised oedema of the retina in the early stage, are characteristic of Quinine amblyopia. Peripheral contraction of fields, particularly for blue is common after recovery. Occasionally blindness is permanent and optic atrophy ensues. There are indisputable cases, in which quinine amaurosis is present in the absence of any characteristic ophthalmoscopic appearances (Elliot-1920).
| Case Report|| |
A case of Quinine amblyopia, where rare ophthalmoscopic changes were observed is reported.
M. G. 22, muslim male, attended the casualty department on 11-2-69, at 2-00 P.M. with the complaints of headache, and fever associated with chills and rigors. The temparature was 101'F. There was typical history of attacks of high temperature associated with chills and rigors followed by sweating. Spleen was not palpable. A clinical diagnosis of malaria was made, the patient was admitted to the medical wards for investigations and was put on mistura Quinine 1 oz.
Next morning, he complained of complete loss of vision in both eyes and was referred to the ophthalmic O.P.D.
Ocular examination revealed the following features. Pupils were dilated and not reacting, vision, perception of light was present in both eyes. Fundus examination revealed bilateral macular oedema, with loss of macular reflexes. Optic disc and retinal vessels were normal and there was no generalised oedema of the retina.
Mistura Quinine was discontinued, retrobulbar injection of Priscol + decadron ½ cc each was given and was repeated on the third day. The patient was put on tablets Pelonin (nicotinic acid) one b.d. for seven days and Neurobion injections daily for seven days.
Pupils regained their shape and reactions by the fifth day, and complete recovery of vision took place by the seventh day. Macular oedema disappeared completely by the seventh day.
Visual fields recorded on the seventh day and fortnightly afterwards for four months did not reveal any contraction for white or colours. Fundus examination fortnightly for four months did not reveal any changes at the macula.
| Comments|| |
Based on the history of administration of Quinine, complete loss of vision, followed by complete recovery of function, a diagnosis of quinine amblyopia was made.
Generalised oedema of the retina in early stages of Quinine amblyopia has been reported (SMITH-1919 quoted by DUKE ELDER) but with the literature available with us, we are not able to find any reports of macular oedema as a feature of Quinine ambly opia. In quinine amblyopia, the blood vessels become very narrow but no narrowing was observed during the whole course. Hence this case is reported.
| Summary|| |
A case of bilateral macular oedema due to Quinine is reported.
| References|| |
Arnold Sorsby: Modern Ophthalmology - Vol. 2 - Butterworths - London (1963).
Duke Elder. S.: Text Book of Ophthalmology - Vol. III - Henry Kimpton - London (1940).
Henry Elliot. R.: Tropical Ophthalmology - Hodder & Stoughton London (1920).