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. Keyhole chloroquine Generalized granuloma annulare hydroxychloroquine Although it is considered rare, retinal toxicity from the intake of Plaquenil can be irreversible even if the drug is discontinued 2, 3. What is Plaquenil Toxicity? The toxicity resulting from the intake of Plaquenil is due to its affinity for melanin-containing structures in the body. Ocular Surgery News The American Academy of Ophthalmology has published several dosing and screening recommendations for hydroxychloroquine to avoid potential retinal toxicity, yet some patients. Symptoms of Plaquenil toxicity are similar to other macular problems and may include Decreased fine vision or difficulty reading. Changes in Color vision. Missing Spots or shadows near the center of the vision. 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). Plaquenil toxicity on retina Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy, Despite Plaquenil dosing recommendations, retinal toxicity remains Plaquenil eye checkChloroquine nhibts clathrin mediated endocytosis 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. Despite Plaquenil dosing recommendations, retinal toxicity.. Plaquenil Toxicity Screening - Retina Group of New York. Plaquenil Toxicity - Bennett & Bloom Eye Centers. Unfortunately, despite their many benefits, both medications, chloroquine Aralen or its analogue, hydroxychloroquine Plaquenil, carry with them a very small risk of permanent vision loss. Eye screening by an ophthalmologist is important to help identify any damage to the eye at the earliest stage possible. 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. Jan 18, 2019 Hydroxychloroquine Plaquenil was originally used to treat malaria and is now used mostly to treat rheumatological and dermatological diseases. Its most frequent use now is for Rheumatoid Arthritis RA and Lupus and is often very effective in mitigating the joint and arthritic symptoms these diseases can cause.