Inhibition of critical enzymes & interference with the metabolic functions of retinal pigment epithelium (RPE) & photoreceptors. Both drugs apparently have a selective affinity for melanin, so it gets concentrated in RPE & uveal tissue & is retained for long periods, even after its usage is stopped. Accumulation of pigment laden cells in outer retinal layers 3. Chloroquine malaria tablets cost Ocular follow-up in regards to hydroxychloroquine Plaquenil side effects mouth sores Ocular findings of HCQ retinal toxicity as detected by various screening modalities. A female patient was diagnosed with HCQ retinal toxicity at the age of 53 years, having taken HCQ for 12 years at 400 mg/day. Hydroxychloroquine can cause irreversible retinal toxicity, resulting in bilateral bull’s eye retinopathy, but is regarded as less toxic to the retina than chloroquine and it does not cause the corneal deposits seen with chloroquine therapy. However, Hydroxychloroquine and chloroquine CQ have been associated with irreversible visual loss due to retinal toxicity. Hydroxychloroquine retinal toxicity is far more common than previously. Symptoms: can be asymptomatic Earliest symptoms - difficulty in reading/ fine tasks due to central / paracentral scotomas Gradually these enlarge & involve fixation, reducing visual acuity later. The earliest histopathologic change, even before RPE damage, appears to be membranous cytoplasmic bodies in ganglion cells and degenerative changes in photoreceptor outer segments. Damage & reduction of photoreceptors It increases with daily dose & duration & varies from 1-28% without any predilection for any particular age, sex or race. Hydroxychloroquine toxic retinopathy Multimodal Imaging in Plaquenil Toxicity, Hydroxychloroquine DermNet NZ Plaquenil bronchospasmPlaquenil side effects sunPlaquenil trackid sp-006 Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014;153–60. Wolfe F, Marmor MF Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res Hoboken 2010, 626775-784. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Hydroxychloroquine retinopathy Eye. Retinal Physician - Hydroxychloroquine Maculopathy An Update.. Chloroquine retinopathy, is a form of toxic retinopathy damage of the retina caused by the drugs chloroquine or hydroxychloroquine, which are sometimes used in the treatment of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. This eye toxicity limits long-term use of the drugs. This article is from June 2011 and may contain outdated material. Download PDF. Many systemic medications may cause retinal toxicity. One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine Plaquenil, a chloroquine derivative. Retinal photograph showing classic “bull’s eye” retinopathy of hydroxychloroquine toxicity, which represents atrophy of the retinal pigment epithelium. This is a relatively late change, and good screening can detect toxicity before any bull’s eye is visible.