Hydroxychloroquine retinopathy after short-term therapy.

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.