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. Plasmodium falciparum chloroquine resistance Plaquenil generic name Nov 01, 2015 The incidence of retinal toxicity is associated with the cumulative dose of the drug, increasing significantly beyond 1,000 g of HCQ. This cumulative dose is created when the common dose of 400 mg/day is used for 6.8 years. Hydroxychloroquine is metabolized and secreted by both the liver and the kidneys. And before treatment is initiated with hydroxychloroquine, a complete ophthalmic examination should be performed to determine any baseline maculopathy. Ophthalmologists should also follow the most current screening guidelines established by the Academy, 1 recently revised in light of new findings. Symptoms and Signs. Symptoms. In some people, Plaquenil can cause a condition called hydroxychloroquine retinopathy, often referred to as bulls-eye maculopathy. The condition sometimes resembles a target, or bulls-eye ring, on the retina surrounding the macula. 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). Hydroxychloroquine bull's eye maculopathy guidelines Differential of Bull's Eye Maculopathy - Eyedocs, Hydroxychloroquine-Induced Retinal Toxicity - American. Plaquenil use icd 10Ophthalmologic complication of hydroxychloroquinePlaquenil toxicity continuing educationHydroxychloroquine sulfate discount card Mar 02, 2018 The new guideline on screening for hydroxychloroquine and chloroquine retinopathy is written in response to evidence from the United States that shows that hydroxychloroquine retinopathy is more common than previously recognised. Implementation of the guideline’s recommendations will prevent iatrogenic visual loss. RCOphth guideline Hydroxychloroquine and Chloroquine.. Plaquenil Side Effects on Your Eyes and Vision. Monitoring for hydroxychloroquine retinopathy Eye. Bull’s eye maculopathy describes a number of different conditions in which there is a ring of pale-looking damage around a darker area of the macula. The macula can often appear to have circular bands of different shades of pink and orange. Age of onset and severity of sight loss varies, and it can be inherited in many ways. Taking Hydroxychloroquine develop toxicity2 It’s rare for side effects to occur with Plaquenil if the medication is dosed properly Side effects Blurred vision, bull’s eye maculopathy, scotoma, vortex keratopathy, headache, accommodative dysfunction, whitening of eyelashes, phototoxicity3 Bull’s eye maculopathy is a rare dystrophy, also known as benign concentric annular macular dystrophy BCAMD. It causes a dartboard, or ring-shaped, a pattern of damage around the macula. This characteristic damage can also be caused by other inherited retinal conditions, or by long-term use of drugs which suppress the immune system as part of treatment for lupus or rheumatoid arthritis.