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. Chloroquine authophagy Does plaquenil lower blood pressure Plaquenil antibiotic interactions The more serious side effect is the retinal toxicity possibility. Initially early retinal findings are often asymptomatic despite some subtle blind spots. Later patients can develop a bilateral “bull’s eye maculopathy,” which is where a ring of retinal base retinal pigment epithelium is effected and lost. A parafoveal early bulls-eye maculopathy is evident in both eyes. AAO GUIDELINES AAO recommendations published in 2016 suggested that daily dosage of hydroxychloroquine should be less than 5.0 mg/kg of real body weight. 3 At these doses, the risk of toxicity is minimal in early years but increases with duration of use. 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. Pattern of Retinopathy Although the locus of toxic damage is parafoveal in many eyes, Asian. 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). Plaquenil toxicity bull's eye maculopathy Hydroxychloroquine Plaquenil Toxicity and Recommendations for Screening, Retina Today - Imaging in Hydroxychloroquine Toxicity April. Hydroxychloroquine retinopathy doseRemove hydroxychloroquine 200 mg tabletHydroxychloroquine sulfate 200Plaquenil and gabapentinChloroquine myopathy Plaquenil Toxicity - Bulls Eye Maculopathy 162 views 70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Plaquenil Toxicity - Bulls Eye Maculopathy - Retina.. Recommendations on Screening for Chloroquine and.. Bull's-eye maculopathy due to hydroxychloroquine toxicity. 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. The presence of bull’s-eye maculopathy indicates the disease has been progressing for years, resulting in foveal thinning and likely vision loss. 8 SD-OCT is a highly sensitive and reproducible imaging modality used in the detection of Plaquenil retinal toxicity. The preferential loss of photoreceptor IS/OS junction makes SD-OCT an ideal tool. Hydroxychloroquine Maculopathy An Update on Screening and Diagnosis A brief guide for imaging SHIRI SHULMAN, MD. H ydroxychloroquine HCQ; Plaquenil, Sanofi, Bridgewater, NJ is an antimalarial agent that is also commonly used as a treatment for a variety of rheumatologic and dermatologic conditions, such as rheumatoid arthritis and systemic lupus erythematosus.