Ocular toxicity of hydroxychloroquine

Abstract

Background: Hydroxychloroquine sulfate is an anti-malarial drug commonly used in the treatment of autoimmune disorders, such as rheumatoid arthritis, Sjogren's syndrome and systemic lupus erythematosus. Although hydroxychloroquine is less toxic than chloroquine, it is associated with ocular toxicities, the most serious of which is toxic maculopathy. Case Report: A 53-year-old Caucasian female presented for a routine eye exam. Her medical history was positive for rheumatoid arthritis which had been treated with 400 mg of hydroxychloroquine per day for the past five years. Her best corrected visual acuity was 20/30 (6/9) in the right eye and 20/25 (6/7.5) in the left eye. She was found to have color vision defects and central scotomas in each eye. Amsler grid was unremarkable. Fundus photos did show mild retinal pigmented epithelial changes, however no bull's eye maculopathy was noted. Automated perimetry revealed the presence of central scotomas in each eye. It was suspected that these findings were related to toxic maculopathy secondary to hydroxychloroquine. Conclusion: Although the incidence of hydroxychloroquine retinopathy is quite rare, it is important that all eye care providers screen their patients on a yearly basis. This examination should include distance visual acuity, color vision, Amsler grid, biomicroscopy of the cornea, dilated fundus exam, and automated perimetry. Management of these patients requires cessation of the drug. Once the drug is discontinued, the symptoms may or may not regress.