Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. Review

Abstract

Hydroxychloroquine sulfate (HCQ, Plaquenil) is an analogue of chloroquine (CQ), an antimalarial agent, used for the treatment of systemic lupus erythematosus, rheumatoid arthritis and other autoimmune disorders. Its use has been associated with severe retinal toxicity, requiring a discontinuation of therapy. Because it presents potential secondary effects including irreversible maculopathy, knowledge of incidence, risk factors, drug toxicity and protocol screening of the patients it represents important data for the ophthalmologists. Thus, it is imperative that rheumatologists, medical internists and ophthalmologists are aware of the toxicity from hydroxychloroquine they should also be careful to minimize its occurrence and effects.

Keywords: bull’s eye maculopathy; hydroxychloroquine sulfate; screening tool.

Fig. 1

[] Bull’s eye maculopathy. A 55-year-old female who had been taking hydroxychloroquine for 10 years before the onset of symptoms. (A) Color fundus photos showing bull’s-eye maculopathy. (B) Fundus autofluorescence with central mottled hypo autofluorescence with the surrounding rim of hyper autofluorescence. (C) SD-OCT shows marked parafoveal thinning of the retina, especially of the outer photoreceptor layers.