REVIEW – September 2019

Hydroxychloroquine retinopathy

Authors: Katrin Sõnajalg, Kalev Nõupuu, Reili Rebane

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Hydroxychloroquine (HCQ) is a commonly used medication in the management of systemic autoimmune diseases (3). HCQ is a very effective drug and has a good safety profile compared to other systemic medications (2, 3). Despite that one has to keep in mind the possible toxic effects on the retina, the innermost layer of the eye, which can lead to serious visual function damage. Studies have shown that HCQ toxicity towards retina is highly dependent on the daily dose and the duration of the therapy (4). Recent guidelines and studies highlight the most important risk factors for developing HCQ induced retinal damage and give instructions for regular screening of long-term users to prevent retinal changes and visual dysfunction. It is recommended to keep daily dosage <5,0 mg/kg real weight (4). Annual screening is indicated after five years of therapy (4) and should include the following tests: SD-OCT, central visual field testing and FAF where possible (2, 3). If there are specific and repeatable changes in the screening tests, it is recommended to stop treatment with HCQ and search for other treatment possibilities (2, 3, 15).