Ocular toxicity and hydroxychloroquine: guidelines for screening

Chloroquine and hydroxychloroquine (4-aminoquinolones) are used by dermatologists for the treatment of a wide range of disorders. It is widely recognized that their use may lead to ocular complications, but policies for ophthalmological screening and follow-up vary widely. In this article, the current literature on the ocular complications of antimalarials is reviewed, together with the results of a recent survey of dermatological practice on screening. New recommendations for ophthalmological screening recently produced by the Royal College of Ophthalmologists, the British Association of Dermatologists and the British Association of Rheumatologists are presented. It is recommended that baseline screening should include an assessment of renal and liver function, an enquiry about visual impairment and the recording of near visual acuity. Follow-up should comprise an enquiry about visual problems at each clinic visit and assessment of visual acuity once yearly. The multidisciplinary nature of the committee producing the new guidelines will hopefully mean that they will be acceptable to and usable by all those who routinely prescribe antimalarial drugs.