Hydroxychloroquine retinopathy is dose- and duration-dependent and irreversible once established. Keep the daily dose at or below 5 mg/kg actual body weight. Arrange a baseline retinal examination within the first year, then annual screening with OCT and visual fields from five years of use, or sooner in those at higher risk: higher dose, kidney disease, tamoxifen use or pre-existing maculopathy. Patients of Asian descent may show a more peripheral pattern of damage, so screening should cover beyond the central field.
- Keep the hydroxychloroquine dose at or below 5 mg/kg actual body weight per day.
- Arrange baseline retinal examination within the first year of treatment.
- Start annual OCT and visual field screening after five years, or earlier in higher-risk patients.
- Reduce the dose in kidney impairment and review if eGFR falls.
- Ask the eye service to look beyond the central field in patients of Asian descent.
Why it matters
Retinopathy is preventable by dosing and detectable before symptoms, but only if screening is arranged.
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