Hydroxychloroquine retinopathy is dose- and duration-dependent and irreversible, but it is detected early by modern screening. Keep the daily dose at or below 5 mg/kg of actual body weight.
Arrange a baseline eye examination within the first year, then annual screening with automated visual fields and spectral-domain OCT from five years of use, or earlier with risk factors such as kidney disease, tamoxifen use or a higher dose. Asian patients may show damage outside the central macula, so wider field testing is advised.
- Keep hydroxychloroquine at or below 5 mg/kg actual body weight a day
- Arrange a baseline retinal examination within the first year
- Screen annually from five years, or sooner with kidney disease, tamoxifen or high dose
- Ask for wider-field testing in Asian patients, including Indian patients
Why it matters
Retinal damage is irreversible but avoidable with correct dosing and screening.
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