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. Plaquenil and optic neuropathy Hydroxychloroquine bone marrow suppression Hydroxychloroquine and phototherapy Fundus photography. Visible HCQ retinopathy is often a late clinical finding Fig. 2. Early signs of HCQ retinopathy may present subtle changes in RPE but may also be subclinical Fig. 3. Therefore, fundus photography is not recommended by the AAO guidelines and has an equivalent bearing on HCQ retinopathy screening as dilated fundus examination. However, some clinicians obtain fundus photography to document their findings. Most patients are now screened with OCT, visual field testing, and fundus examination. Amsler grid and color vision testing may also be used. Retinal damage from chloroquine and hydroxychloroquine is often irreversible. References. Elman A, Gullberg R, Nilsson E, Rendahl I, Wachtmeister L. Chloroquine retinopathy in patients with rheumatoid. Chloroquine retinopathy, is a form of toxic retinopathy damage of the retina caused by the drugs chloroquine or hydroxychloroquine, which are sometimes used in the treatment of autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. This eye toxicity limits long-term use of the drugs. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Fundus in chloroquine Hydroxychloroquine Plaquenil Toxicity and., Spotlight Case Chloroquine - The American Society of. Plaquenil and trintellix interactions Purpose To evaluate melanin-related near-infrared fundus autofluorescence NIA, excitation 787 nm, emission 800 nm, lipofuscin-related fundus autofluorescence FAF, excitation 488 nm, emission 500 nm, optical coherence tomography OCT, and multifocal electroretinography mfERG in patients with chloroquine CQ retinopathy. Chloroquine retinopathy lipofuscin- and. - SpringerLink. Chloroquine retinopathy - Wikipedia. Drug induced maculopathy - EyeWiki. The mechanism of chloroquine and hydroxychloroquine toxicity is not well understood. Chloroquine has an affinity for pigmented melanin-containing structures, which may explain its toxic properties in the eye. Melanin serves as a free-radical stabilizer and can bind toxins, including retinotoxic drugs. Chloroquine Retinopathy Is Fluorescein Angiography Necessary? ALAN F. CRUESS, MD,* ANDREW P. SCHACHAT, MD,* JAMIE NICHOLL,t JAMES J. AUGSBURGER, MD* Abstract Color fundus photographs and corresponding fluorescein angio grams from 83 patients suspected of having chloroquine retinopathy were reviewed in a retrospective masked study to determine the relative sensitivity of these two photographic. Chloroquine is an anti-malaria medicine that works by interfering with the growth of parasites in the red blood cells of the human body. Parasites that cause malaria typically enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia.