12.2

Hydroxychloroquine Toxicity

Introduction:

Retinal toxicity from hydroxychloroquine is rare, especially when dosed appropriately (≤6.5 mg/kg/day is recommended). After five years of use, the incidence is about 1% and increases with additive use over time. Patients with short stature and liver dysfunction appear to be at greater risk.

Clinical Features:

The findings of hydroxychloroquine retinopathy, even in early and moderate disease, can be clinically silent. Later in the disease, there is a bull’s eye maculopathy that becomes evident (Fig. 12.2.1).

Figure 12.2.1 Color photograph of advanced hydrochloroquine retinopathy with a classic bull’s eye maculopathy.

OCT Features:

OCT is one of the most useful and sensitive diagnostic tests for identifying retinal toxicity due to hydroxychloroquine. Findings in early disease can be very subtle and may only show up clearly on a retinal thickness map (Fig. 12.2.2

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