Clinical electrophysiology in quinine induced retinal toxicity

A 43-year-old woman was evaluated 9 months after a deliberate overdose of quinine. The patient's visual acuity was 20/20, but she had lost all peripheral vision beyond approximately 30 degrees eccentricity. The multifocal electroretinography (mfERG) and optical coherence tomography are described for the first time in this condition. The mfERG shows electronegative waveforms beyond 6 degrees . The mfERG response density is reduced at all retinal locations. Optical coherence tomography shows thinning of the middle and inner retina by 25 to 35%, with preservation of the photoreceptor layer. Recent regulatory restrictions in off-label uses of quinine products should help to reduce the incidence of adverse toxic reactions.