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Hydroxychloroquine retinopathy after short-term therapy.

Brandon N Phillips¹, Dal W Chun

¹Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.

Retinal Cases & Brief Reports

|November 6, 2014

Summary

This case report highlights hydroxychloroquine toxicity, a rare but serious condition causing vision loss. Patients on higher-than-recommended doses or combined with NSAIDs require vigilant ophthalmologic screening.

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Area of Science:

Ophthalmology
Rheumatology
Clinical Toxicology

Background:

Hydroxychloroquine (Plaquenil) is widely prescribed for inflammatory conditions.
While generally safe, long-term use can lead to retinal toxicity.
Current guidelines recommend annual screenings after five years of therapy.

Observation:

A 56-year-old woman developed decreased vision after 48 months of hydroxychloroquine therapy.
Ophthalmic examination revealed bilateral bull's eye maculopathy and parafoveal atrophy.
The patient received a daily dose exceeding the ideal recommendation and concurrently used high-dose nabumetone.

Findings:

The patient presented with significant visual field defects and characteristic retinal lesions.
Optical coherence tomography confirmed retinal atrophy.
This case suggests potential synergistic toxicity with nonsteroidal anti-inflammatory drugs (NSAIDs).

Implications:

Confirms the need for baseline and annual ophthalmologic screening for hydroxychloroquine users.
Highlights the importance of considering higher-than-recommended hydroxychloroquine doses as a risk factor.
Suggests evaluating annual eye exams for patients on high-dose NSAIDs concurrently with hydroxychloroquine.