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Hydroxychloroquine: retinal screening

  • Drugs and toxicity

Hydroxychloroquine is safe for most patients, but years of use can damage the retina for good. Screening finds it before vision is lost.

Updated

See it in 3D: Macula · Retina

What it is

Hydroxychloroquine, used in lupus, rheumatoid arthritis and other autoimmune diseases, can accumulate in the retinal pigment epithelium and damage the photoreceptors around the fovea. Toxicity is uncommon in the first years but rises with cumulative exposure. The damage is irreversible and can progress after stopping, so the aim of screening is to detect it before the patient notices symptoms.

What to know

  • Main risks: daily dose high for body weight, duration over five years, kidney disease, concurrent tamoxifen, pre-existing macular disease.
  • Early toxicity has no symptoms; late toxicity causes a ring-shaped (bull's-eye) maculopathy and central field loss.
  • Screening tests: automated central visual fields and spectral-domain OCT, with other tests as needed.
  • Chloroquine is more toxic than hydroxychloroquine.

Toxicity and risks

  • The prescriber is responsible for keeping the daily dose appropriate for real body weight and kidney function.
  • In some patients, especially of Asian ancestry, damage starts outside the central area and needs wider field testing.
  • Stopping the drug when toxicity is found is decided with the prescribing specialist.

Next step / Initial management

  • Baseline eye exam within the first year of treatment.
  • Yearly screening after five years of use, or earlier if there are risk factors.
  • Signs of toxicity: stop the drug in agreement with rheumatology and follow up with ophthalmology.
  • Review the dose when kidney function or body weight changes.

Test yourself

Think of the answer, then tap the question to see it.

When should retinal screening start in a patient on hydroxychloroquine?

With a baseline exam in the first year, then yearly after five years of use, or earlier with risk factors.

Which tests are used to screen for hydroxychloroquine toxicity?

Automated central visual fields and spectral-domain OCT.

Why is early detection important?

Because the damage is irreversible and can progress after the drug is stopped.

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Connections

See it in 3D2

The structures of Durgical's 3D anatomy where it is found.

In Pharmacology3

← All of ophthalmology

Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: Chloroquine and Hydroxychloroquine Toxicity (StatPearls Publishing (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.