Hydroxychloroquine retinopathy is dose- and duration-dependent and irreversible. Keep the daily dose at or below 5 mg/kg of actual body weight, and reduce it in significant renal impairment.
Arrange a baseline retinal examination early in treatment, and annual screening with OCT and visual fields after five years, or sooner where there are added risks such as kidney disease, tamoxifen use or a higher dose. Patients should report any change in reading or central vision.
- Keep hydroxychloroquine at or below 5 mg/kg actual body weight per day.
- Reduce the dose in significant renal impairment.
- Arrange baseline retinal assessment early in treatment.
- Start annual OCT and field screening after five years, earlier if risk factors exist.
Why it matters
Hydroxychloroquine is often continued for decades, and the retinal damage it causes does not recover.
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