PURPOSE: To report a side effect of quinacrine therapy for malaria. DESIGN: Case report. METHODS: Review of clinical chart and photographs. SETTING: Private retina practice. RESULTS: A patient developed a bilaterally symmetric bull's-eye maculopathy 45 years after taking quinacrine for 18 months as prophylaxis against malaria. Progression of the clinical picture was documented over 15 years of follow-up. The clinical picture was identical to that of chloroquine and hydroxychloroquine maculopathy. CONCLUSIONS: Low dosages of quinacrine used for malaria prophylaxis can be associated with a delayed, severe maculopathy indistinguishable from chloroquine maculopathy in certain patients.