A CASE OF QUININE AMAUROSIS MANIFEST- 
ING ITSELF PRIMARILY IN ONE 
EYE ONLY. 
C. M. HOBBY, M.D., Iowa City, Ia. 
dr/g. 6, 1881.-Miss M. S., aged 21, was brought to me by a 
physician of a neighboring town with the following history. 
Some weeks previously the patient suffered from very severe 
left supra-orbital neuralgia ; subsequently what was supposed to 
be episcleritis of the left eye occurred, accompanied by conjunc- 
tival injection and oedema of the eyelids. The neuralgia being 
considered malarial in character, was treated with large doses of 
quinine, and fomentations of belladonna were applied to the eye. 
Under this treatment the paroxysms of pain diminished in fre- 
quency, and the conjunctival and subconjunctival injection disap- 
peared. Very large doses of quinine were required to produce 
cinchonism. No belladonna had been used during the preceding 
week. 
At the time the patient came under my observation, she pre- 
sented an anaemic appearance, had very little appetite, and was 
still suffering from occasional attacks of neuralgia. There was no 
injection of the conjunctiva or sclerotic ; the right eye was appa- 
rently normal ; in the left eye the pupil was widely dilated and 
not appreciably affected by light. O D S = ; O S S = 
No improvement obtainable by glasses. 
Ophthalmoscopic examination showed intense ischaemia of both 
retince. No test of visual field was made at this time. 
I retained the patient under observation, unable to make a 
satisfactory diagnosis. In order to determine how much the dila- 
tation of the left pupil was due to the former use of belladonna, 
I instilled a drop of a one-half-per-cen-t solution of eserine. 
Reprinted from the Archives of Ophthalmology, Vol. xi, No. i, March, 
1882. Case of Quinine Amaurosis. 
35 
On the next day the pupil had nearly returned to its normal 
dimensions, and the acuteness of vision had increased to - 
The patient's vision continued to improve for the next nine days, 
when S was for both eyes. During that time she had received 
only indifferent medication. At this time, the neuralgia becoming 
prominent and markedly periodical, I ordered her twenty grains 
of quinine, to be taken in two doses, one hour apart. The next 
morning she felt much better. The acuteness of vision being as 
before, she was permitted to return home. 
On the fourth day following (Aug. 20th) she returned with both 
pupils dilated to the utmost. O D S = - ; OSS = -2-. At 
this time she reported that the left eye began to get worse upon 
her return home, but she noticed no trouble with the right eye 
until the previous day. The visual field was now examined (by 
using black objects on white paper), and found reduced in both 
eyes to about one tenth of the normal. Ophthalmoscopic exami- 
nation showed profound ischaemia of both retinae. Recognizing 
the probable existence of " quinine amaurosis," I commenced the 
use of strychnia hypodermically, increasing the quantity each 
time until the physiological effects were apparent. The improve- 
ment was rapid, and in ten days the acuteness of vision had re- 
turned to - for both eyes, and the visual field of each had 
doubled. During the use of strychnia the malarial symptoms dis- 
appeared and the general physical condition improved. She was 
then directed to use a ferruginous tonic and discharged. Six 
weeks later I found the acuteness of vision unchanged and the 
O. S. 
O. D. 36 
C. M. Hobby. 
visual field much increased in extent, but still less than half the 
normal. 
The accompanying figures show the gradual extension of the 
visual fields, their limits having been determined on Aug. 20th, 
Aug. 30th, and Nov. 15th. 
The inference to be drawn from this case would seem to be that 
the toxic effect of quinia may primarily manifest itself in a single 
eye.