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 blood test Plaquenil 200 cost The macular changes associated with toxicity are potentially serious and are related to dosage and duration. 1-3 Established maculopathy is classically characterized as moderate reduction of visual acuity and an obvious "bulls eye" macular lesion. End stage maculopathy is characterized by severe reduction in visual acuity and severe atrophy of. Fundus examination shows a subtle bull’s-eye macular lesion characterized by a central island of pigment surrounded by a depigmented zone of RPE atrophy, which itself is encircled by a hyperpigmented ring. The lesion may be more obvious on autofluorescence than on ophthalmoscopy. This stage can be missed before cataract surgery. A dilated fundus exam revealed small cups with good rim coloration and perfusion O. U. There was a yellow-white elevated lesion in the macula of the right eye, seen here. The macula in the left eye showed mild changes in the retinal pigment epithelium, but we saw no fluid or subretinal hemorrhages. The peripheral retina was attached. 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). Chloroquine eye exam for macular lesions Eye screening for patients taking hydroxychloroquine Plaquenil, Why “Not 20/20” After an Excellent Phacoemulsification Surgery? Hydroxychloroquine type 2 diabetes fdaHydroxychloroquine and aps400mg plaquenil at nightPain medication plaquenil She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine Plaquenil 200mg bid 6.5mg/kg for 10 years, which was stopped one year prior to presentation. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Dilated Exam Spots Macular Lesion. Bull's Eye Maculopathy – Causes, Complications, and Treatment.. The goal of monitoring/screening is to identify early macular damage prior to irreversible vision loss or even before visible signs of bull’s eye maculopathy. And although the current guidelines do not discuss the importance of continuous ocular care with an annual comprehensive eye exam, we believe that it is an essential consideration. 1. Published case reports of chloroquine retinopathy rarely include details of daily dosage, but 30 reports where this information was available included 78 patients who developed impaired visual acuity an 13 had received daily doses of 250 mg or less. Eleven. The macular changes are potentially serious and are related to dosage and length of time taking hydroxychloroquine. Blurred vision and defective color vision may be found early. Advanced retinopathy is characterized by marked reduction of visual acuity and a “bulls eye” macular lesion which is absent in early involvement.