Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Hydroxychloroquine induced drug rash Pots dysautonomia plaquenil Nov 18, 2011 Early retinopathy has been defined as an acquired, persistent paracentral scotoma visualized on automated visual field testing without any observable fundus changes. 1 Reports have shown that the visual loss from HCQ toxicity is less likely to be reversible once fundus changes are present. 1,2,3 Although newer testing modalities, such as. Nov 05, 2016 B Nonreproducible central scotoma red arrow in her 10-2 visual field test isn’t typical of hydroxychloroquine retinopathy. C Blue fundus autofluorescence imaging is normal. D Near infrared reflectance imaging shows a hyperreflective annulus yellow arrow which has low sensitivity and specificity for hydroxychloroquine retinopathy. Eye damage due to Plaquenil is not common,” he says. “Rarely will anybody who has good vision and minimal symptoms develop loss of central vision or ability to read if annual screening is done and visual are symptoms reported as soon as they occur so the medication can be stopped if toxicity occurs. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Visual field loss in plaquenil retinopathy Value of Red Targets and Pattern Deviation Plots in Visual., Avoiding the Traps of Hydroxychloroquine Use Plaquenil wbcPlaquenil to treat skin rash Advanced cases may demonstrate widespread retinal pigment epithelium atrophy, with a reduced visual field and decreased night vision. 3. Visual field. Parafoveal sensitivity loss is an early sign that may precede fundus changes. A computerized white-on-white 10-2 visual field test enables good resolution to test for macular sensitivity. Retinal Physician - Hydroxychloroquine Maculopathy An.. Protecting your eyesight when taking Plaquenil Lupus.. Hydroxychloroquine retinopathy A review of imaging. The use of 4-aminoquinolines is generally considered contraindicated in the presence of retinal or visual field changes, whether attributable to 4-aminoquinoline compounds or to any other etiology. However, in the treatment of acute attacks of malaria caused by susceptible strains of plasmodia, these agents may be considered if potential benefits are anticipated to outweigh the risks. When allowed to advance, hydroxychloroquine retinal toxicity leads to loss of up to three visual functions acuity, peripheral vision and night vision. Signs. On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull. Hydroxychloroquine retinopathy is thought to be infrequent but of increasing prevalence because patients use the drug for many years or have undue exposure from overdosage or renal failure. 1 Screening in previous decades was primarily by subjective functional measures, such as the central visual field.