Hydroxychloroquine retinopathy is dose- and duration-dependent and irreversible. Keeping the daily dose at or below 5 mg per kg of actual body weight substantially reduces risk.
A baseline eye examination within the first year, then annual screening with OCT and automated visual fields from five years of use — sooner with kidney disease, tamoxifen, or higher doses — catches toxicity before vision is affected. In Asian patients, damage may first appear outside the parafovea, so wider-field testing is advised.
- Prescribe hydroxychloroquine at no more than 5 mg/kg actual body weight per day.
- Arrange a baseline eye examination within the first year of treatment.
- Start annual OCT and visual field screening after five years, or earlier with kidney disease or tamoxifen.
- Ask for wider-field testing in Asian patients, including Indian patients.
Why it matters
Hydroxychloroquine is used for decades in lupus and arthritis, and toxicity is preventable but not reversible.
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