Hydroxychloroquine retinopathy is dose- and duration-dependent and irreversible once established. Keeping the daily dose at or below 5 mg/kg of actual body weight substantially lowers risk, so the dose should be reviewed when weight falls. Arrange a baseline eye examination within the first year of treatment, then annual screening with OCT and visual fields from five years onward, or sooner in those at higher risk — kidney impairment, tamoxifen use, pre-existing macular disease or higher doses. Asian patients may show a pericentral pattern of damage, which needs wider-field testing to detect.
- Keep hydroxychloroquine at or below 5 mg/kg of actual body weight per day.
- Arrange baseline eye assessment in the first year of treatment.
- Start annual OCT and visual field screening after five years, or earlier with risk factors.
- Review the dose when weight or kidney function changes.
Why it matters
Retinal damage is preventable with correct dosing and detectable before vision is lost.
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