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Table of Diagnostic Points in Quinine and Malarial Amblyopia (see p. 75)
Quinine Amblyopia Malarial Amblyopia
History.—Quinine taken in large doses, not less than 30 grains. History.—Quinine may have been taken, but not necessarily in large doses.
Onset.—Sudden, accompanied by deafness; both eyes are affected. Onset.—Not usually sudden, but it may be so if hæmorrhage has occurred in the macular region. There is no deafness, and both eyes are not necessarily affected.
Pupils.—Widely dilated, and whilst loss of vision continues they do not react to light. Pupils.—React to light.
Vision.—Completely lost for a time. Vision.—Never completely lost.
Ophthalmoscopic appearances.—A white haze over fundus; cherry-red spot at macula; optic disc pale; retinal vessels markedly constricted. Ophthalmoscopic appearances.—There is optic neuritis; optic disc is of characteristic greyish-red colour; retinal hæmorrhages, and sometimes vitreous opacities.
Termination.—Usually some permanent defect in the field of vision or in colour vision. Central vision recovers first; optic disc is unusually white, and retinal vessels small. Termination.—Some cases recover completely; in others greater or less permanent defect of vision remains.
Treatment.—Stop quinine. Amyl nitrite has been recommended to induce dilatation of retinal vessels. Treatment.—Give quinine.
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