Quinine Amaurosis*

Two year electrophysiology follow-up in quinine amblyopia. A case report

A 19-year-old girl presenting with quinine amblyopia had serial electrophysiology studies over a 2 year period. Visually evoked responses and the electro-oculogram were abolished early. By 2 months the VER and visual acuity had returned to normal. The electroretinogram, initially mildly subnormal, became virtually abolished by 2 months. No recovery in cone function took place. Of the rods 50% regained function with normal latency by 1 year, but receptor sensitivity did not return to normal until 2 years after ingestion. The electro-oculogram also recovered slowly over a 2 year period. This pattern suggest that quinine exerts a direct toxic effect on the cells of the outer retina and pigment epithelium, as well as on the ganglion cells.

Ocular manifestations of drug abuse

Abuse of drugs, including some used clinically and others with no legal or clinical use, can cause ocular injury and disease. Ocular manifestations of drug abuse may be due to the substances themselves, to invasive methods of administration, or to injury suffered during states of altered consciousness. Grouping the drugs into five categories (opiates, marijuana, stimulants, depressants and hallucinogens), the authors describe the pharmacologic, congenital, toxic, infectious, embolic, and psychological ocular manifestations of their abuse.

Management of quinine overdose

The successful management of a case of quinine overdose with blindness is described. From a review of the literature, treatment of moderate poisoning with ingestion of less than 10 g of quinine should consist of immediate and thorough gastric lavage, forced acid diuresis, immediate bilateral stellate ganglion blockage repeated if there is clinical improvement in vision. With a larger overdose or when coma or convulsions occur haemodialysis, peritoneal dialysis or preferably haemoperfusion should be considered.

Forced acid diuresis and stellate ganglion block in the treatment of quinine poisoning

A case of quinine poisoning with associated amblyopia is reported. Treatment with a forced acid diuresis and bilateral stellate ganglion blocks is described.

Ocular quinine toxicity

A 25-year-old woman had no light perception in either eye 14.5 hours after ingesting 3.7 to 4.7 g of quinine. Fundus photographs showed mild venous distention and retinal haziness, but normal arteries. The electroretinogram, electrooculogram, and visual-evoked potential were all mildly abnormal. Two days after the patient ingested quinine, her visual acuity returned to 6/6 (20/20) with a markedly constricted visual field. The classic late fundus appearance of quinine toxicity, marked vascular narrowing, and disk pallor developed within six months. Visual fields remained constricted to 12 degrees with small temporal islands.