Hydroxychloroquine retinal toxicity is dose- and duration-dependent. Keep the daily dose at or below 5 mg/kg of actual body weight, and reduce it in kidney impairment.
Arrange a baseline retinal examination within the first year, then annual screening with OCT and visual fields after five years of use, or sooner with higher doses, kidney disease or tamoxifen. Early toxicity is reversible only if caught before symptoms.
- Keep hydroxychloroquine at or below 5 mg/kg actual body weight per day.
- Reduce the dose in significant kidney impairment.
- Arrange baseline retinal assessment within the first year.
- Screen annually with OCT and fields after five years, or earlier if risk factors are present.
Why it matters
Retinopathy is preventable with dosing discipline and is missed without screening.
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