Quinine amblyopia treated with stellate ganglion block.

Bankes, James L Kennerley; Hayward, J A; Jones, M. B.

doi:10.1136/bmj.4.5832.85

Cited by 16 publications

(5 citation statements)

References 5 publications

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“…Fundoscopy is usually normal at the onset of visual symptoms but after blindness has developed there may be marked changes including constriction of retinal arterioles, retinal oedema and a cherry red spot at the macula. Optic atrophy may develop several weeks or months later (Elliott, 1918;Braveman et al, 1948;Stuart, 1963;Bricknell et al, 1967;Kennerley Bankes et al, 1972;Murray & Jay, 1983;Dyson et al, 1985;Canning & Hague, 1988).…”

Section: Discussionmentioning

confidence: 99%

“…As these were retrospective, not randomized and involved small numbers interpretation of the results is difficult but there is no clear evidence of benefit. Many of the papers supporting the use of SGB have been single case reports (Redslob et al, 1946;Glick & Mumford, 1955;Stuart, 1963;Bricknell et al, 1967;Kennerley Bankes et al, 1972;Glick & Mumford, 1955;Redslob et al, 1946;Robertson & Kothanda Raman, 1979;Thomas, 1984) which could be subject to bias. A convincing argument against SGB being of any value is that, in patients who have had unilateral SGB performed, there has been no difference in outcome between the treated and untreated eyes Bacon et al, 1988).…”

Section: Discussionmentioning

confidence: 99%

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The management of quinine-induced blindness.

Guly

Driscoll²

1992

Emergency Medicine Journal

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Quinine is rarely taken in overdose (Pearn et al., 1984;Boland et al., 1985). We present a case where blindness resulted from an accidental overdose of only eight tablets of quinine sulphate. Opinion regarding both the aetiology and the management of quinine-induced blindness has altered in recent years (Boland et al., 1984;Dyson et al., 1985;Dyson et al., 1986). This case suggests that expert advice received regarding this condition may not be that recommended in the light of these changes.Case report A 40-year-old man presented to the A&E Department at Hope Hospital at 9 a.m. having become blind overnight. At 8 p.m. the previous day he had developed a mild frontal headache and had taken two of his father's tablets which he believed to be painkillers. His headache did not improve and over the next 8 h he took a further six tablets. During the night he noticed that the street lights became dim and disappeared. When he woke in the morning he was blind and had a buzzing noise in his ears.On examination both pupils were fixed and dilated and there was no light perception in either eye. Fundoscopy was normal. He appeared to have slight hearing impairment but examination was otherwise normal.He brought with him the bottle of tablets he had taken. This contained quinine sulphate tablets which had been prescribed for his father for muscle cramps.Gastric lavage was carried out and repeated doses of activated charcoal were given. The Poisons Information Centre recommended unilateral stellate ganglion block (SGB) after being seen by an opthalmologist. On the advice of the duty ophthalmologist bilateral SGBs were performed at 5.30 p.m.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The management of quinine-induced blindness.

Guly

Driscoll²

1992

Emergency Medicine Journal

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“…Beobachtet wurden folgende Veränderungen: Thrombozytopenie [2,14,21,25], Niereninsuffizienz [5], granulomatöse Hepatitis [8,15,16], Vaskulitis [8-11, 14, 24], aber auch Granulomatosen, Photosensibilisierung [7,17,22,31], sowohl phototoxisch [30] wie auch photoallergisch [28,32] bedingt, eine Kontaktdermatitis bei einem Arbeiter in einer Chininfabrik [33], Hypoglykämie [18] sowie disseminierte intravasale Gerinnung [5,12]. Beobachtet wurden folgende Veränderungen: Thrombozytopenie [2,14,21,25], Niereninsuffizienz [5], granulomatöse Hepatitis [8,15,16], Vaskulitis [8-11, 14, 24], aber auch Granulomatosen, Photosensibilisierung [7,17,22,31], sowohl phototoxisch [30] wie auch photoallergisch [28,32] bedingt, eine Kontaktdermatitis bei einem Arbeiter in einer Chininfabrik [33], Hypoglykämie [18] sowie disseminierte intravasale Gerinnung [5,12].…”

Section: Therapie Und Verlaufunclassified

Akrale Nekrosen nach Therapie mit Chininsulfat wegen Wadenkrämpfen

et al. 2000

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The most common cause of acral cyanosis is vascular spasm which can be induced by several drugs. An 87-year-old woman developed red and livid skin lesions on the fingers of both hands and several toes one month after beginning treatment with quinine sulfate 200 mg daily. The skin lesions progressed to necrosis in some areas. Quinine sulfate is a widely prescribed drug for nocturnal cramps. The following side effects may develop, particularly in the elderly: exanthems, pruritus, urticaria, erythema multiforme, purpura and photosensitivity. Our case points to the possibility of acral necrosis and demonstrates the efficacy of vasodilator treatment.

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“…Retinal arteriolar constriction is the most frequently suggested cause of quinine amblyopia (Braverman et al 1948) and vasodilator therpay with amyl nitrate or nicotinic acid is frequently undertaken. Success has also been claimed with stellate ganglion block (Bankes et al 1972;Valman & White 1977), but recent reviews from two British regional poisoning treatment centres have shown its lack of' efficacy (Boland et al 1985;Dyson et al 1985).…”

mentioning

confidence: 99%

Two year electrophysiology follow‐up in quinine amblyopia

Moloney

Hillery

Fenton

1987

Acta Ophthalmologica

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A 19-year-old girl presenting with quinine amblyopia had serial electrophysiology studies over a 2 year period. Visually evoked responses and the electro-oculogram were abolished early. By 2 months the VER and visual acuity had returned to normal. The electroretinogram, initially mildly subnormal, became virtually abolished by 2 months. No recovery in cone function took place. Of the rods 50% regained function with normal latency by 1 year, but receptor sensitivity did not return to normal until 2 years after ingestion. The electro-oculogram also recovered slowly over a 2 year period. This pattern suggest that quinine exerts a direct toxic effect on the cells of the outer retina and pigment epithelium, as well as on the ganglion cells.

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Quinine amblyopia treated with stellate ganglion block.

Cited by 16 publications

References 5 publications

The management of quinine-induced blindness.

The management of quinine-induced blindness.

Akrale Nekrosen nach Therapie mit Chininsulfat wegen Wadenkrämpfen

Two year electrophysiology follow‐up in quinine amblyopia

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