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. Generalized granuloma annulare hydroxychloroquine Smoking and plaquenil If cornea verticillata is associated with a drug that is known to produce retinal toxicities, most notably hydroxychloroquine, chloroquine, chlorpromazine, and tamoxifen, patients should be routinely monitored with automated visual fields plus spectral-domain optical coherence tomography SD OCT 20. A variety of medications bind with the cellular lipids of the basal epithelial layer of the cornea due to their cationic, amphiphilic properties. Amiodarone, an antiarrhythmic, is the most common cause of corneal verticillata, followed by chloroquine, hydroxychloroquine, indomethacin, and phenothiazines. Disease Entity Cornea verticillata also called vortex keratopathy, whorl keratopathy, or Fleischer vortex describes a whorl-like pattern of golden brown or gray opacities in the cornea. 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. Hydroxychloroquine corneal verticillata Retinal Screening for Hydroxychloroquine Plaquenil Toxicity., Corneal verticillata - American Academy of Ophthalmology Can i take tylenol and plaquenil together Aug 06, 2014 Hydroxychloroquine, sold under the brand name Plaquenil Sanofi-Aventis, is an antimalarial drug that has gained widespread use in treating various autoimmune diseases, including systemic lupus erythematosus and rheumatoid arthritis. 1 By some estimates, more than 150,000 patients are on long-term therapy with this medication in America alone. 2 Retinal toxicity associated with HCQ use is. Multimodal Imaging in Plaquenil Toxicity. What is corneal verticillata? - Quora. Chloroquine and Hydroxychloroquine Toxicity Clinical.. Hydroxychloroquine can cause variable ocular adverse effects including corneal deposits, posterior sub-capsular cataract, ciliary body dysfunction and toxic retinopathy. Toxic retinopathy caused by HCQ has been recognized for many years. Patients with toxic retinopathy usually complain of blurry vision. Hydroxychloroquine is still a safe and beneficial drug for use in rheumatic diseases. Corneal verticillata is less common with HCQ than CQ 7, 21, 22. Retinopathy. Although rare, retinopathy is the major concern expressed by most patients and clinicians using HCQ. Some degree of corneal deposits verticillata can be demonstrated in most patients taking chloroquine, but these changes very rarely impair vision. 4 Corneal deposits occur more frequently with chloroquine than with hydroxychloroquine, 5 are located in the epithelium and subepithelial stroma 6, 7 and are mostly reversible. 7 By contrast.