Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose: We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. Hydroxychloroquine side effects dry eyes Plaquenil mefioquine Chloroquine phosphate tablets bp 250 mg Plaquenil lyme treatment The toxicity associated with these drugs is bilateral bull's-eye maculopathy Figure 2. 13 The precise mechanism by which this occurs is unknown, but the drugs bind to melanin in the retinal pigment epithelium RPE and affect photoreceptor metabolism. In less advanced cases, the only findings may be loss of the foveal light reflex and nonspecific pigmentary abnormalities. In individuals of Asian descent, retinal toxicity may first be noticed outside the macula. In patients of Asian descent, it is recommended that visual field testing be performed in the central 24 degrees instead of the central 10 degrees. It is recommended that hydroxychloroquine be discontinued if ocular toxicity is suspected and Retinal toxicity than ideal body weight and allows estimations of risk that are independent of body habitusMaintaining daily use at 5.0mg/kg or less would keep both the cumulative risk and annual risk of retinal toxicity low, especially for the first 10 years of use.” • Melles RB, Marmor MF. JAMA Ophthalmol. 2014. Toxicity Risk Daily Dose Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using 2.3 mg/kg real weight. Retinal toxicity from plaquenil 2019 Hydroxychloroquine Retinal Toxicity., PLAQUENIL hydroxychloroquine sulfate Label Chloroquine dose in liver abscessImages early plaquenil toxicity fundus autofluorescence 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. The Risk of Retinal Toxicity with Plaquenil - Sjogren's. COPE Disclosures Plaquenil Toxicity Update. Multimodal Imaging in Plaquenil Toxicity. Jun 18, 2019 The classic sign of hydroxychloroquine retinopathy is bilateral “bull’s-eye” appearance of the macula due to disruption of the retinal pigmented epithelium. However, this finding occurs late in the toxicity and once it occurs the likelihood of permanent vision loss is significant so it is not useful as a screening tool. Medication Dosage Currently, one of the primary functional screening tests recommended for the evaluation of Plaquenil retinal toxicity is 10-2 white stimulus automated visual fields; however, research shows Asian patients benefited from 24-2 or 30-2 visual fields, given that toxicity often manifests changes beyond the macula in these patients. 9 Because spectral-domain optical coherence tomography SD-OCT is readily accessible and able to detect early structural damage prior to clinical funduscopic findings. Retinal toxicity related to hydroxychloroquine in patients with systemic lupus erythematosus and rheumatoid arthritis.