Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Chloroquine and nitrifying bacteria Plaquenil discount coupons Sep 15, 2014 Bull’s eye maculopathy. A 55-year-old female who had been taking hydroxychloroquine for 10 years before the onset of symptoms. A Color fundus photos showing bull’s-eye maculopathy. B Fundus autofluorescence with central mottled. Plaquenil Toxicity - Bulls Eye Maculopathy 162 views 70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT Spectral domain optical coherence tomography 1098 views 82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Plaquenil toxicity bull's eye maculopathy Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy, Plaquenil Toxicity - Bulls Eye Maculopathy - Retina. Not diagnosed with rd but on methotrexate and plaquenilSjogrens and plaquenil On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful. Hydroxychloroquine-Induced Retinal Toxicity - American.. Plaquenil Toxicity - Mild - Partial Bull's Eye Maculopathy.. Recommendations on Screening for Chloroquine and.. In early toxicity there are no visible signs, but field, OCT and mfERG changes can be detected. If abnormalities are present only unilaterally, investigate other causes besides hydroxychloroquine toxicity see “Differential Diagnosis of Bull’s-Eye Maculopathy”. Mechanism of Toxicity Later in the disease, patients can develop a bilateral bull's eye maculopathy, characterized by a ring of retinal pigment epithelium RPE depigmentation in the macula, sparing the fovea, which is often accompanied by paracentral and central scotomas. End stage hydroxychloroquine toxicity leads to widespread RPE and retinal atrophy with a loss. Hydroxychloroquine Maculopathy An Update on Screening and Diagnosis A brief guide for imaging SHIRI SHULMAN, MD. H ydroxychloroquine HCQ; Plaquenil, Sanofi, Bridgewater, NJ is an antimalarial agent that is also commonly used as a treatment for a variety of rheumatologic and dermatologic conditions, such as rheumatoid arthritis and systemic lupus erythematosus.