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Editor,—Ocular quinine toxicity from acute overdose is much more rare than in the past. It manifests as severe peripheral vision loss associated with severe retinal arteriole constriction. Although the optic nerve head does not develop characteristic cupping, the extensive field loss can be misinterpreted as glaucomatous in nature. Severe retinal arteriolar constriction and extensive electrophysiological abnormalities can provide help in differentiating these two conditions.
CASE REPORT
This 79 year old non-English speaking, Greek woman was referred for evaluation and management of advanced glaucoma. According to the referring physician, the patient had a history of glaucoma diagnosed approximately 2 years earlier. Intraocular pressures had been in the high teens to low 20s range on a regimen of Xalatan QHS in both eyes. Humphrey visual fields had been obtained revealing severe peripheral loss.
On presentation the patient complained of poor vision for the past few years, the right eye worse than the left and discomfort in the right eye. She had been seen by ophthalmologists in Brazil, Greece, and the United States. She had undergone laser procedures twice in the right eye and once in the left, for glaucoma. Her past medical history was only significant for falls resulting in an ankle and hip fracture approximately 3 months ago. Review of systems was non-contributory. The patient was on no systemic medications except for pain medications for a painful hip. She was also taking Xalatan 0.005% QHS in both eyes. According to the referring …