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Year : 1972  |  Volume : 20  |  Issue : 4  |  Page : 187-188

Quinine amblyopia

Department of Ophthalmology, Government Hospital, Masulipatnam, (A.P.), India

Correspondence Address:
C M Sarma
Department of Ophthalmology, Government Hospital, Masulipatnam, (A.P.)
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Source of Support: None, Conflict of Interest: None

PMID: 4671314

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How to cite this article:
Sarma C M. Quinine amblyopia. Indian J Ophthalmol 1972;20:187-8

How to cite this URL:
Sarma C M. Quinine amblyopia. Indian J Ophthalmol [serial online] 1972 [cited 2023 Nov 28];20:187-8. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1972/20/4/187/34637

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 Top

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 Top

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 Top

A case of bilateral macular oedema due to Quinine is reported[3].

  References Top

Arnold Sorsby: Modern Ophthal­mology - Vol. 2 - Butterworths - London (1963).  Back to cited text no. 1
Duke Elder. S.: Text Book of Ophthalmology - Vol. III - Henry Kimpton - London (1940).  Back to cited text no. 2
Henry Elliot. R.: Tropical Ophthal­mology - Hodder & Stoughton London (1920).  Back to cited text no. 3


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