Common Symptoms

Patients are often asymptomatic when hydroxychloroquine (HCQ) retinopathy is found during screening given the initial decrease in vision is paracentral to fixation. Sometimes patients may notice changes in vision at near instead of at distance given the decrease in paracentral visual field.

Symptomatic loss of vision usually presents when severe retinal damage from HCQ retinopathy has already occurred and the paracentral field loss has progressed to a central scotoma in severe disease. Photopsia, metamorphopsia, reduced color vision, and peripheral field loss are reported to be found in later stages of the disease.

86.1.2 Exam Findings

Retinal pigment epithelium (RPE) stippling and loss of the foveal reflex in the macula in early disease.

Bull’s eye maculopathy with parafoveal RPE depigmentation in late disease (▶ Fig. 86.1).

86.2 Key Diagnostic Tests and Findings

86.2.1 Optical Coherence Tomography

Early

Initially with thinning of inner retinal layers followed by loss of parafoveal photoreceptor inner segment/outer segment junction leading to parafoveal thinning of outer nuclear layer leading to outer displacement of inner retinal structures toward RPE resulting in the “flying saucer sign” on spectral-domain optical coherence tomography (SD-OCT; ▶ Fig. 86.2).

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