Retinal toxicity from hydroxychloroquine is related to daily dose by actual body weight and to duration of use. Keeping the dose at or below 5 mg/kg/day of actual body weight lowers the risk. Arrange a baseline eye examination early in treatment, then annual screening with OCT and visual fields after five years of use, or sooner if there are risk factors such as reduced kidney function or tamoxifen use. Early toxicity is often symptomless.
- Calculate the hydroxychloroquine dose from actual body weight, at or below 5 mg/kg/day.
- Reduce the dose if kidney function falls significantly.
- Arrange a baseline retinal examination within the first year of treatment.
- Screen annually with OCT and visual fields after five years, or earlier with risk factors.
Why it matters
Retinopathy is irreversible and often silent until advanced, but it is largely preventable with dosing and screening.
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