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. Plaquenil tablet doses Plaquenil and eye twitching Ocular effects of hydroxychloroquine Spectral Domain Optical Coherence Tomography SD-OCT shows that there is early thinning of outer retinal layers, typically with loss of the parafoveal photoreceptor inner segment/outer segment IS/OS junction and central foveal sparing. There is preservation of the RPE and external limiting membrane. Doses ≥ 5 mg/kg/day real weight of hydroxychloroquine 2.3 mg/kg/day of chloroquine are associated with higher risk of toxicity. Doses lower than 5 mg/kg/day have low risk 1% for the first 5 years, and below 2% between 5-10 years of use. Previously described OCT findings in HCQ toxicity include loss of the external limiting membrane, disruption of the outer ellipsoid zone, parafoveal thinning of the outer nuclear layer and RPE damage. 6,7,10 Despite these various changes, numerous studies have supported the notion that relative “foveal resistance” is common in HCQ toxicity, as demonstrated by preservation of the subfoveal outer retinal layers, accounting for the intact central visual acuity that can be seen even in. 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. Hydroxychloroquine retinal toxicity oct The Risk of Retinal Toxicity with Plaquenil, Hydroxychloroquine And Chloroquine Screening 2016 AAO. Hydroxychloroquine lupusChloroquine drug 13000 Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. Hydroxychloroquine-Induced Retinal Toxicity - American.. Multimodal Imaging in Plaquenil Toxicity. Hydroxychloroquine Plaquenil Toxicity and.. The American Academy of Ophthalmology has published several dosing and screening recommendations for hydroxychloroquine to avoid potential retinal toxicity, yet some patients still experience permanent vision loss resulting from hydroxychloroquine retinopathy due to improper dosing of the drug and improper screening. FA showed subtle bulls-eye maculopathy, and the repeated OCT showed slight parafoveal OCT ellipsoid zone EZ loss consistent with Plaquenil toxicity. She had already stopped the medication and was again educated that further progression and vision loss could happen. When taken at high doses and for long durations, hydroxychloroquine has been known to cause parafoveal retinal toxicity. This toxicity is often insidious, causing serious, irreversible visual deterioration if not detected early.