Optic Atrophy Following Cerebral Malaria

Abstract

A 46-year-old woman presented with a diminution of vision in the left eye. She had a history of cerebral malaria due to Plasmodium falciparum 30 years earlier, during which she was comatose and developed severe bilateral visual loss, progressing to no perception of light in the right eye. Current examination showed no perception of light in the right eye and best-corrected visual acuity of 6/24 in the left eye, with early lenticular opacities in both eyes. Fundus examination revealed chalky white optic disc pallor in both eyes, with nasal rim sparing in the left. Visual fields demonstrated severely constricted fields in the left eye. A diagnosis of optic neuropathy secondary to cerebral malaria was made. The findings were consistent with primary optic atrophy, likely due to optic neuritis from malarial infection or rare quinine-induced retrobulbar neuritis.