Photo Essay |

Quinine Iris Toxicity

Andrew Traill, MBBS, Hons; Raj Patmaraj, FRANZCO; Ehud Zamir, MD, FRANZCO
Arch Ophthalmol. 2007;125(3):430. doi:10.1001/archopht.125.3.430.
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A 29 year-old woman had visual loss following ingestion of 6 g of quinine in a suicide attempt in 1965. Her visual acuity rapidly deteriorated to light perception bilaterally, but recovered to 6/9 in both eyes within a month. She had residual nyctalopia and dyschromatopsia. In the following years the irides developed progressive, diffuse atrophy. The pupils became miotic, oval and nonreactive (Figure 1). There was marked depigmentation of the iris stroma and pigment epithelium, similar to that seen in ocular albinism (Figure 2). There was bilateral disc pallor and diffuse retinal vascular narrowing. An electroretinogram was done in 1978 and showed a flat photopic response and a scotopic response with an absent b-wave. Goldman perimetry (1978) showed a constricted visual field of 20° with a V4 target. Her visual acuity in 2005 was 6/36 in the right eye due to age-related cataract and 6/9 in the left eye.

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Figure 1.

Slitlamp photographs taken in 2005 showing blue irides with horizontally oval pupils. A indicates right eye; B, left eye.

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Figure 2.

Extensive iris transillumination is seen with coaxial light. A indicates right eye; B, left eye.

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