Images in Clinical Medicine: Hydroxychloroquine Retinal Toxicity

Sumamry

  • 57yo F
  • presented fot annual oph evaluation
  • PMH
    • SLE
    • Sjögren synd
    • hydroxychloroquine 400mg × 8yrs
    • visual
      • acuity 20/20
      • nl color vision
      • standard achromatic perimetry: paracentral scotomas
      • OCT: loss of retinal inner / outer segments

Terminology

Original

Fig

A 57-year-old woman presented for her annual ophthalmic evaluation. Her medical history was remarkable for diagnoses of systemic lupus erythematosus and Sjögren’s syndrome. She had been taking 400 mg of hydroxychloroquine daily for 8 years. Her ophthalmic history included a baseline visual acuity of 20/20 in each eye, normal color vision, and normal findings on automated visual-field testing. At year 8 of therapy, she reported no visual symptoms. Testing indicated that her color vision had diminished from baseline in both eyes. Standard achromatic perimetry revealed paracentral scotomas in each eye (Panel A [showing the left eye]), and macular spectral-domain optical coherence tomography revealed a loss of the retinal inner and outer segments (Panel B [showing the left eye], arrows), findings consistent with hydroxychloroquine retinal toxicity. The results of slit-lamp and funduscopic examinations were normal. Long-term therapy with hydroxychloroquine is commonly used in the treatment of autoimmune diseases. Routine eye examination with appropriate ancillary testing should be considered for patients receiving long-term hydroxychloroquine therapy. In this case, the hydroxychloroquine treatment was stopped, and treatment with methotrexate was initiated by her rheumatologist.