Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Cheapest price for hydroxychloroquine How many hours does plaquenil work in the body Does plaquenil reduce fevers On screening recommendations for hydroxychloroquine retinopathy published new updated guidelines in the journal Ophthalmology The 2016 guidelines have lowered the recommended safe dosage to 5.0 mg/kg per day of real body weight. Additionally, it is important to recognize that patients of Asian descent tend to have perifoveal Jan 05, 2020 Advanced hydroxychloroquine toxicity presents as a bullseye maculopathy. Since retinal toxicity is usually irreversible, early detection of retinal toxicity and cessation of the offending agent is the best treatment 2 3. The guidelines recommend that all patients planning to take hydroxychloroquine long term i.e. over five years have a baseline examination in a hospital eye department ideally within six months. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Hydroxychloroquine bull's eye maculopathy guidelines Determine risk for hydroxychloroquine retinal toxicity., Hydroxychloroquine toxicity - EyeWiki Chloroquine primaquine lyme babesiaSun and plaquenilChloroquine lysing the endosomeHydroxychloroquine actavisPlaquenil arthritis treatment Maculopathy has become evident have not shown any significant recovery of vision.5 Most individuals who develop evidence of toxicity have received a cumulative chloroquine dose of 300 g, or a daily dose greater than 3 mg/kg, 3,4 or a daily dose of hydroxychloroquine greater than 6.5 mg/kg. 6 It must be highlighted that although irreversible. Chloroquine-induced bull’s eye maculopathy. Monitoring for hydroxychloroquine retinopathy Eye. Bull’s eye maculopathy Macular Society. And before treatment is initiated with hydroxychloroquine, a complete ophthalmic examination should be performed to determine any baseline maculopathy. Ophthalmologists should also follow the most current screening guidelines established by the Academy, 1 recently revised in light of new findings. Symptoms and Signs. Symptoms. Abstract. Background The American Academy of Ophthalmology recommendations on screening for chloroquine CQ and hydroxychloroquine HCQ retinopathy are revised in light of new information about the prevalence of toxicity, risk factors, fundus distribution, and effectiveness of screening tools. Fundus changes on biomicroscopy, including bull's eye maculopathy, are indicative of fairly advanced hydroxychloroquine-induced retinal toxicity which is largely irreversible despite cessation of the medication.