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. Withdrawing from plaquenil Plaquenil side effects insomnia Even though 4 of the 9 patients with HCQ retinopathy in his study had advanced damage, “only 1 of the 9 patients complained of visual disturbances at the time of diagnosis.” Summing Up. The main point of the revised guidelines is that “you want to get people on the right dose,” Dr. Marmor said. 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. Ocular manifestations of toxicity include whorl-pattern epithelial keratopathy, subcapsular cataracts, retinopathy, optic atrophy, paralysis of accommodation, and extraocular muscle palsy. 1. The risk of retinal toxic effects from chloroquine is approximately 1% after 5 to 7 years of use. 2 Hydroxychloroquine is less toxic than chloroquine. The. 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 retinopathy guidelines How to Succeed in Plaquenil Screenings, Chloroquine retinopathy is there a safe daily dose? Plaquenil and sleepinessEstradiol plaquenil combinationPlaquenil salePlaquenil caused seizures May 16, 2011 Hydroxychloroquine Plaquenil; HCQ has been an important and effective drug for the treatment of lupus erythematosus and related autoimmune and inflammatory diseases for half a century, although its potential to cause retinal damage continues to raise concern among rheumatologists and ophthalmologists. Hydroxychloroquine Retinopathy Still Alive and Well - The.. Chloroquine Retinopathy Nephrology JAMA Ophthalmology.. Hydroxychloroquine And Chloroquine Screening 2016 AAO.. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Marmor MF1, Kellner U, Lai TY, Lyons JS, Mieler WF; American Academy of Ophthalmology. Author information 1Eye Institute at Stanford, Stanford University, Palo Alto, California, USA. Aug 30, 2011 Diagnosis Hydroxychloroquine-induced retinal toxicity Discussion. Chloroquine CQ and hydroxychloroquine Plaquenil HCQ have been used for many years, initially for the treatment of malaria but now more commonly for the treatment of inflammatory diseases such as rheumatoid arthritis and lupus 1. Guidelines on screening for retinopathy associated with hydroxychloroquine toxicity were initially published by the Academy in 2002. These guidelines were updated in February of this year, given the emergence of more sensitive diagnostic techniques and the recognition that risk of toxicity from years of hydroxychloroquine use is greater than.