title: Quinine blindness.
abstract: A young women was treated with intravenous quinine and chloramphenicol for suspected severe malaria and/or typhoid fever. On the second day of quinine therapy (after 2.25 g of quinine) she suddenly developed total bilateral loss of vision. Both drugs were stopped and cyclandelate therapy was started. She showed slight improvement in vision but on referral her visual acuity was limited to seeing waving hand movement only; visual fields were constricted and colour vision was absent. Both pupils were fixed and dilated. The fundi showed macular oedema and attenuated retinal arteries. She was treated with dexamethasone, cyclandelate, vitamin B complex and vitamin C. Colour vision was completely recovered after 5 days of treatment. Full recovery of the direct light reflex occurred after 10 days. Visual acuity improved slowly over a period of one month to 6/15 vision in both eyes. At this time macular oedema and retinal arteriolar attenuation were still present but less severe. In the context of this case report the condition of quinine blindness is briefly reviewed and the management discussed.
authors.affiliation: Faculty of Medicine, University of Papua New Guinea, Port Moresby General Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Naraqi
authors.forename: S
authors.initials: S
authors.lastname: Okem
authors.forename: N
authors.initials: N
authors.lastname: Moyia
authors.forename: T K
authors.initials: TK
authors.lastname: Dutta
authors.forename: B
authors.initials: B
authors.lastname: Zzferio
authors.forename: D
authors.initials: D
authors.lastname: Lalloo
mesh_terms: D000328:Adult; D001205:Ascorbic Acid / Q000627:therapeutic use; D001766:Blindness / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D002701:Chloramphenicol / Q000627:therapeutic use; D003495:Cyclandelate / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008288:Malaria / Q000188:drug therapy*; D009887:Ophthalmoscopy; D011803:Quinine / Q000008:administration & dosage / Q000009:adverse effects*; D012017:Referral and Consultation; D014435:Typhoid Fever / Q000188:drug therapy*; D014792:Visual Acuity; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex; D003495:Cyclandelate; D002701:Chloramphenicol; D003907:Dexamethasone; D011803:Quinine; D001205:Ascorbic Acid