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Recovery from blindness following accidental quinine overdose
  1. Hildegard Nikki Hall1,2,
  2. Andrew J Tatham1
  1. 1Princess Alexandra Eye Pavilion, Edinburgh, UK
  2. 2MRC Human Genetics Unit, MRC Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Hildegard Nikki Hall, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh EH3 9HA, UK; nikki.hall{at}ed.ac.uk

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Case

A 46-year-old woman presented with sudden loss of vision in both eyes, apparent since waking. She also complained of partial hearing loss. The previous evening she had experienced difficulty sleeping due to (long-standing) restless legs and had self-medicated with quinine, taking an accidental overdose of 1.8 g.

On admission, she was alert but unable to perceive light in either eye, and had fixed, dilated pupils. Other than mild bilateral sensorineural hearing loss, the remainder of the neurological examination was normal. She was haemodynamically stable, but her ECG showed QT interval prolongation at 501 ms (normal 350–440); she therefore received intravenous sodium bicarbonate for suspected myocardial toxicity.

Ophthalmological review that day confirmed a visual acuity of no light perception and a bilateral afferent pupillary defect. Fundal examination suggested mild retinal oedema. Given the profound visual loss, we prescribed a 4-week course of oral nimodipine 60 mg 4-hourly, …

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