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. Hydroxychloroquine 4 cream Plaquenil and inflammation Plaquenil 400 mg 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. 2,3. The associated classic retinal toxicity is described as a bull’s eye maculopathy ring of depigmented retinal pigment epithelium that spares the foveal area. The side effect that is of greatest concern is retinal toxicity. Retinal toxicity of Plaquenil may manifest itself with subtle disturbances of the retinal pigment epithelium which may eventually lead to complete destruction of the macula in the form of bull’s-eye maculopathy. 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. 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 Retina Today - Imaging in Hydroxychloroquine Toxicity April., The Risk of Retinal Toxicity with Plaquenil - Sjogren's Plaquenil kidney side effectsGeneric pill hydroxychloroquine photo 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. Recommendations on Screening for Chloroquine and.. Retinal Physician - Hydroxychloroquine Maculopathy An Update on.. Plaquenil Toxicity - Bulls Eye Maculopathy - Retina.. Later in the disease, patients can develop a bilateral bull's eye maculopathy, characterized by a ring of retinal pigment epithelium RPE depigmentation in the macula, sparing the fovea, which is often accompanied by paracentral and central scotomas. End stage hydroxychloroquine toxicity leads to widespread RPE and retinal atrophy with a loss. Causes of Bull's Eye maculopathy include cone dystrophy cone-rod dystrophy chloroquine or hydroxychloroquine toxicity ceroid lipofuscinosis Stargardt's and fundus flavimaculatus fenestrated sheen macular dystrophy parafoveal atrophy of RPE secondary to AMD central areolar choroidal dystrophy benign concentric annular macular dystrophy Juvenile Batten's disease fucosidosis clofazimine maculopathy 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.