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. Plaquenil fk Sulfasalazine and hydroxychloroquine Stomach pain from plaquenil Screening recommendation. Guidelines and recommendations for screening for retinal toxicity have evolved over the years. In 2002 the American Academy of Ophthalmology AAO first proposed screening recommendations for HCQ associated retinal toxicity, with the salient points being 14 1. Chloroquine and hydroxychloroquine 4-aminoquinolones are used by dermatologists for the treatment of a wide range of disorders. It is widely recognized that their use may lead to ocular complications, but policies for ophthalmological screening and follow-up vary widely. Apr 20, 2011 Since the initial screening and monitoring recommendations were published in 2002, there have been reports of retinal toxicity associated with the use of Plaquenil. Furthermore, the advent of novice sensitive diagnostic modalities has led to a revision of the recommended guidelines for patients using Plaquenil see “2011 Plaquenil Screening. 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). Hydroxychloroquine and ocular toxicity recommendations on screening 2009 Ocular toxicity and hydroxychloroquine guidelines for., Ocular toxicity and hydroxychloroquine guidelines for screening. Plaquenil brown spotsChloroquine dnaChloroquine macrophagesSpilled water on plaquenil Chloroquine and Hydroxychloroquine Toxicity. Nicholas M. Hickley. the current Royal College of Ophthalmologists guidelines from October 2009 do not advocate screening but recommend the use of Amsler chart and central visual field testing to detect early disease after. Hydroxychloroquine and ocular toxicity recommendations on screening. Chloroquine and Hydroxychloroquine Toxicity JAMA.. New Plaquenil Guidelines. New Guidelines for Hydroxychloroquine Visual Screening. Hydroxychloroquine and ocular toxicity recommendations on screening October 2009. HIR36837 Publisher Royal College of. Diseases 2 Chemicals 1 Aims This guideline considers the avoidance of optical damage when using the drug hydroxychloroquine, which is also used to treat rheumatoid arthritis and lupus. Intended audience. Hydroxychloroquine HCQ has been widely prescribed by Rheumatologists since the 1950s. Retinal toxicity, particularly with treatment duration 5 years, is a recognised complication. It is thought that although the bull’s eye seen on ophthalmic exam represents a disruption of the pigmented part of the retina, it is the photoreceptors that are the targets of hydroxychloroquine toxicity. Notably the new recommendations were based on a single study published in 2014 that evaluated the prevalence of and risk factors for hydroxychloroquine retinal toxicity.