One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine (Plaquenil), a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus. Ra treatments plaquenil Hydroxychloroquine vitamin d On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful. OCT scan top of normal macula compared to Plaquenil Toxicity bottom with loss of the outer retinal tissue around the macular center red boxes View more retina images at Retina Rocks, the world’s largest online multimedia retina image library and bibliography repository. Plaquenil toxicity first affects small areas of the retina between 5° and 15° from the fovea. Figures 2 and 3 show three patients at different stages of toxicity. Figure 2 bottom right shows a color display of normal mfERGs. The amplitude of the mathematically derived b-wave of the mfERG is displayed in a color scale. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. Oct appearance of plaquenil toxicity Protecting your eyesight when taking Plaquenil Lupus., Plaquenil Toxicity - Bennett & Bloom Eye Centers Plaquenil children Of course the aim is avoid drug related retinal toxicity, which on ophthalmic examination, appears as the classic Bull’s eye change affecting the macula. Once retinal toxicity from hydroxychloroquine occurs, it is thought that the retinal changes are permanent and the disease can progress even if hydroxychloroquine is stopped for 1 to 3 years. My Take on New Ocular Screening Guidelines for Plaquenil.. Retina Today - Evaluating Hydroxychloroquine Toxicity With Multifocal.. Side Effects of Plaquenil Hydroxychloroquine, Warnings, Uses. In early cases of Plaquenil toxicity, an early indicator of damage is the appearance of a paracentral scotoma seen on automated visual field testing in the absence of fundus changes. 18 Each of the testing strategies can be used to detect early toxicity changes, but the presentation of the visual field effects will vary. Due to the central area being depressed in the 24-2 and 30-2 testing strategies, it is difficult to discern the central 2-degree field of sparing seen in the 10-2 tests. SD-OCT Unlike time domain optical coherence tomography, SD-OCT has the resolution to detect localized thinning of the retina in the parafoveal region. On SD-OCT, loss or thinning of the parafoveal and perifoveal photoreceptor layer and focal disruption of outer segment laminations are consistent with toxicity 13. The American Academy of Ophthalmology has published several dosing and screening recommendations for hydroxychloroquine to avoid potential retinal toxicity, yet some patients still experience permanent vision loss resulting from hydroxychloroquine retinopathy due to improper dosing of the drug and improper screening.