OCULAR MANIFESTATIONS OP GENERAL DISEASES 525 



brought on by a chronic malarial cachexia. These are opaque greyish 

 dots. 



It abates in from four to eight weeks. 



Vitreous opacities are due to hjemorrhages and serous effusion. 



Amaurosis is due to atrophy of the optic nerve. 



In retinochoroiditis the papillae are obscured and the retina hazy. 

 The condition is due to the parasites in the vessels. A pigmented 

 retina is left. If there is embolism of the central artery, less rare, there 

 is sudden loss of vision. Optic neuritis and oedema may be caused 

 by the blockage. 



Paralysis of the accommodation is not uncommon in malarial con- 

 ditions, but secondary iritis is rare. 



Supraorbital and ciliary neuralgia are common. 



Amblyopia is less frequent and may be caused by the disease or 

 the treatment of it, i.e., malaria or quinine. The points of differen- 

 tiation are set forth in the following table : — 



QUININE AND MALARIAL AMBLYOPIA. (After Manson.j 



QUININE 

 History — 



Quinine must have been taken in large 

 doses, not less than thirty grains. 



Onset — 



Sudden, accompanied by deafness ; both 

 eyes are affected 



Pupils 



Widely dilated, and whilst loss of vision 

 continues they do not react to light 



Vision — 



Completely lost for a time 



Ophthalmoscopic appearances — 



A white haze over fundus; cherry-red 



spot at macular; optic disc pale; 



retinal vessels markedly constricted 



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 



Treatment — 



Stop quinine. Amyl nitrite has been 

 recommended to induce dilatation of 

 retinal vessels 



MALARIA 



Quinine may have been taken but not 

 necessarily in large doses 



Not usually sudden, but it may be so if 

 haemorrhage has occurred in the macular 

 region. There is no deafness, and both 

 eyes are not necessarily affected 



React to light 



Never completely lost 



There is optic neuritis ; optic disc is of 

 characteristic greyish - red colour; le- 

 tinal haemorrhages and sometimes 

 vitreous opacities 



Some cases recover completely; in others 

 greater or less permanent defect of 

 vision remains 



Give quinine 



Quinine causes buzzing in the ears with partial or complete deaf- 

 ness. It is usually temporary, but is sometimes permanent. 



