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. Plaquenil maculopathy dose Tylenol and hydroxychloroquine Plaquenil for lyme arthritis New Screening Guidelines for Hydroxychloroquine Toxicity Experts explain their role in clinical practice. Stephen G. Schwartz, MD, MBA • William F. Mieler, MD. Hydroxychloroquine Plaquenil, Sanofi-Aventis remains widely used in the treatment of various rheumatologic disorders. Jun 11, 2018 The Royal College of Ophthalmologists recommendations on screening for hydroxychloroquine and chloroquine users in the United Kingdom executive summary. Imran H. Yusuf 1, Screening recommendation. Guidelines and recommendations for screening for retinal toxicity have evolved over the years. In 2002 the American Academy of Ophthalmology AAO first proposed screening recommendations for HCQ associated retinal toxicity, with the salient points being 14 1. 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). Hydroxychloroquine and ocular toxicity recommendations on screening 2009 Ocular Toxicity of Hydroxychloroquine Request PDF, The Royal College of Ophthalmologists recommendations on. Plaquenil lupus medicationPlaquenil eye symptomsAzulfidine for rheumatoid arthritis vs plaquenilPlaquenil burning eyes Retinal toxicity is irreversible and can progress after cessation of hydroxychloroquine, thus early screening is important to limit potential vision loss. Baseline screening and annual screening after five years is recommended. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Screening for hydroxychloroquine retinal toxicity Current.. Hydroxychloroquine and ocular toxicity recommendations.. Mechanism of Toxicity. The mechanism of hydroxychloroquine retinal toxicity has yet to be fully elucidated. Studies have shown that the drug affects the metabolism of retinal cells and also binds to melanin in the RPE, which could explain the persistent toxicity after discontinuation of the medication. Screening guidelines were updated this year, with some pertinent changes for our profession to note. Cumulative dose is no longer a risk factor, but more of a tool in the screening of our patients. The Royal College of Ophthalmologists—Hydroxychloroquine and Ocular Toxicity. Recommendations on Screening, October 2009. 9. Frederick W, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus.