Hydroxychloroquine Retinopathy

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).



(a,b) Fundus photos with bilateral bull’s eye maculopathy with parafoveal depigmentation of the retinal pigment epithelium in hydroxychloroquine toxicity.


Fig. 86.1 (a,b) Fundus photos with bilateral bull’s eye maculopathy with parafoveal depigmentation of the retinal pigment epithelium in hydroxychloroquine toxicity.


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).



Progression of optical coherence tomography (OCT) findings in hydroxychloroquine toxicity. (a) OCT showing loss of parafoveal photoreceptor inner segment/outer segment junction (i.e., ellipsoid zone [


Fig. 86.2 Progression of optical coherence tomography (OCT) findings in hydroxychloroquine toxicity. (a) OCT showing loss of parafoveal photoreceptor inner segment/outer segment junction (i.e., ellipsoid zone [EZ]). (b) The “flying saucer sign” with parafoveal thinning of outer nuclear layer leading to outer displacement of inner retinal structures toward retinal pigment epithelium (RPE). (c) Advanced disease demonstrating loss/atrophy of outer retinal layers with parafoveal RPE irregularities. EZ-RPE thickness maps demonstrating (d) en face visualization of early atrophy parafoveal EZ loss and (e) bull’s eye configuration of EZ-RPE thinning; courtesy of Justis P. Ehlers.

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Mar 24, 2020 | Posted by in OPHTHALMOLOGY | Comments Off on Hydroxychloroquine Retinopathy

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