She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Plaquenil and hydroxychloroquine Hydroxychloroquine sulfate vs hydroxychloroquine Pictures of skin rash from plaquenil Sjogren's hydroxychloroquine 44 To report expanded SD-OCT findings of HCQ retinopathy that may assist the clinician in earlier diagnosis. To characterize structural changes of HCQ retinopathy with SD-OCT after drug cessation. Setting Private practice and academic institution. Patient Population Patients at New England Eye Center and Ophthalmic Consultants of Boston in Boston, MA diagnosed with HCQ retinopathy and followed. SD Spectral Domain OCT With early Hydrochloroquine retinopathy, SD-OCT can detect outer layer retinal abnormalities Specifically, SD-OCT can detect loss of the perifoveal photoreceptor inner segment/outer segments line PIL At the macula, an ovoid appearance can appear described as “flying saucer” sign by Chen, et al18 ILM IPL OPL Purpose. To investigate the distribution of outer retinal changes in hydroxychloroquine HCQ retinopathy and explore optical coherence tomography OCT protocols to maximize the sensitivity of HCQ retinopathy detection in Asian patients. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Oct hydroxychloroquine retinopathy Hydroxychloroquine toxicity - EyeWiki, Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy Plasmodium falciparum samuel martin chloroquineIs plaquenil compatible with omega 3 fish oilChloroquine diphosphate in transfection Importance Hydroxychloroquine sulfate is widely used for the long-term treatment of autoimmune conditions but can cause irreversible toxic retinopathy. Prior estimations of risk were low but were based largely on short-term users or severe retinal toxicity bull’s eye maculopathy. Toxic Retinopathy With Hydroxychloroquine Therapy - JAMA. Optical Coherence Tomography Protocols for Screening of.. Retinal Physician - Hydroxychloroquine Maculopathy An Update.. Spectral domain optical coherence tomography SD OCT images, red-free photos, and fundus autofluorescence FAF demonstrate a spectrum of findings seen with different stages of hydroxychloroquine retinopathy. Note the increased signal of choroidal vessels. RCOphth guideline Hydroxychloroquine and Chloroquine Retinopathy NEW screening recommendations February 2018 2 March 2018. The new guideline on screening for hydroxychloroquine and chloroquine retinopathy is written in response to evidence from the United States that shows that hydroxychloroquine retinopathy is more common than previously recognised. Hydroxychloroquine HCQ retinopathy can result in permanent vision loss. In early stages of HCQ retinopathy, patients are usually asymptomatic with preservation of visual acuity.