Table of ContentsView AllTable of ContentsHydroxychloroquine RetinopathyRisk FactorsTestingFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Hydroxychloroquine Retinopathy
Risk Factors
Testing
Frequently Asked Questions
Plaquenil (hydroxychloroquine) is used to treat several inflammatory conditions as well asmalaria, but you should be aware that Plaquenil side effects can affect your eyes and vision if you are taking it.
Plaquenil is in a class of drugs called disease-modifying anti-rheumatic drugs (DMARDs), which are used to decrease inflammation, pain, and joint damage. While today it is used to treatautoimmune conditions, such asrheumatoid arthritisandlupus, it was used first as an anti-malaria drug.
The eye-related side effects of Plaquenil are uncommon but severe enough to warrant paying extra attention to what’s going on.
Eric Audras / Getty Images
In some people, Plaquenil can cause a condition calledhydroxychloroquine retinopathy, often referred to asbull’s-eye maculopathy.The condition can cause the appearance of a target, or bull’s-eye ring, on the retina surrounding themacula. The retina is the tissue in the back of the eye that receives light; the macula is the area responsible for central vision.
Hydroxychloroquine retinopathy is rare. It is most often seen in cases where the dosage is high or a person has been taking the drug for several years. When it does occur, Plaquenil side effects can be devastating to your vision.
Initially, central vision is not affected. You may notice a ring of disrupted vision that can interfere with reading.
SymptomsIf you have odd visual changes at any time while taking Plaquenil, see a healthcare provider. These changes may include blurry vision, circular patterns, or changes in how you see color.
Symptoms
If you have odd visual changes at any time while taking Plaquenil, see a healthcare provider. These changes may include blurry vision, circular patterns, or changes in how you see color.
Taking Plaquenil for more than five years is a key risk factor but it is not the only one. Others include:
The cumulative dose of Plaquenil (the total amount you’ve taken over time) was previously considered to be “simple indicator of risk,” according to the American Academy of Ophthalmology, “but this does not hold up well.” The organization says that “duration of use relative to daily dose/weight” is a more accurate measure.
Most rheumatologists recommend that people undergo a baselineeye examinationprior to starting Plaquenil.Because retinal toxicity is much more likely after five to seven years, annual exams should start once you’ve been on the drug for five years.
Some healthcare providers favor more frequent testing to check for Plaquenil-related vision changes, including a full evaluation every 18-24 months during the first five years and annually thereafter.
Guidelines for Plaquenil screenings have expanded over the years and the technology for detecting retinal changes has improved. Currently, a Plaquenil eye exam should including the following:
A healthcare provider may recommend frequent, simple at-home tests in addition to extra eye exams.
Summary
Plaquenil (hydroxychloroquine) offers benefits for many people who take the drug to treat inflammatory diseases, like lupus, or as an anti-malarial medication. Yet Plaquenil has side effects that may harm your eyes and vision in potentially serious and permanent ways.
The long-term use of Plaquenil increases the risk of a rare but severe condition called hydroxychloroquine retinopathy. It’s for this reason that healthcare providers typically monitor people more closely when they have taken Plaquenil for more than five years.
Frequently Asked QuestionsNo, but in some cases stopping the drug will limit the damage. This is why it’s so important for people taking Plaquenil to be carefully monitored. Yet some researchers are finding new patterns of eye damage beyond the classic “bulls-eye ring” on the retina. They’ve also found that eye damage may progress even after stopping the drug, and that Plaquenil may still be present in your liver, kidneys, and other body tissues for quite some time.Yes, although there is no known or established level of hydroxychloroquine in adults that’s considered toxic or lethal. That said, mild toxicity may occur at doses of less than 2 grams, moderate toxicity between 2 and 4 grams, and severe toxicity at levels greater than 4 grams. Doses over 5 grams may prove fatal because of electrolyte imbalances and impacts on heart function.Learn MoreWhat Are Electrolyte Imbalances?
No, but in some cases stopping the drug will limit the damage. This is why it’s so important for people taking Plaquenil to be carefully monitored. Yet some researchers are finding new patterns of eye damage beyond the classic “bulls-eye ring” on the retina. They’ve also found that eye damage may progress even after stopping the drug, and that Plaquenil may still be present in your liver, kidneys, and other body tissues for quite some time.
Yes, although there is no known or established level of hydroxychloroquine in adults that’s considered toxic or lethal. That said, mild toxicity may occur at doses of less than 2 grams, moderate toxicity between 2 and 4 grams, and severe toxicity at levels greater than 4 grams. Doses over 5 grams may prove fatal because of electrolyte imbalances and impacts on heart function.Learn MoreWhat Are Electrolyte Imbalances?
Yes, although there is no known or established level of hydroxychloroquine in adults that’s considered toxic or lethal. That said, mild toxicity may occur at doses of less than 2 grams, moderate toxicity between 2 and 4 grams, and severe toxicity at levels greater than 4 grams. Doses over 5 grams may prove fatal because of electrolyte imbalances and impacts on heart function.
Learn MoreWhat Are Electrolyte Imbalances?
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shippey EA, Wagler VD, Collamer AN.Hydroxychloroquine: an old drug with new relevance.Cleve Clin J Med. 2018;85(6):459-467. doi:10.3949/ccjm.85a.17034American Osteopathic College of Dermatology.Hydroxychloroquine.Yusuf I, Sharma S, Luqmani R, Downes SM.Hydroxychloroquine retinopathy.Eye (Lond).2017;31(6):828–845. doi:10.1038/eye.2016.298Corradetti G, Violanti S, Au A, Sarraf D.Wide field retinal imaging and the detection of drug associated retinal toxicity.Int J Retina Vitreous. 2019;5(Suppl 1):26. doi:10.1186/s40942-019-0172-0Ahn SJ, Lee BR.Hydroxychloroquine retinopathy update.J Rheum Dis. 2018;25(3):153-157. doi:10.4078/jrd.2018.25.3.153Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF;American Academy of Ophthalmology. recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision).Ophthalmology. 2016;123(6):1386-1394. doi:10.1016/j.ophtha.2016.01.058Muller R.Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities.Rheumatol Int. 2021;41(7):1189-1202. doi:10.1007/s00296-021-04868-6Lin T, Marmor MF, Barbhaiya M, et al.Baseline retinal examinations in patients with systemic lupus erythematosus newly initiating hydroxychloroquine treatment in a US Medicaid systemic lupus erythematosus population, 2000–2010.Arthritis Care Res. 2018;70(11):1700-1706. doi:10.1002/acr.23530Petitdemange A, Felten R, Sibilia J, Martin T, Arnaud L.Prescription strategy of antimalarials in cutaneous and systemic lupus erythematosus: an international survey.Ther Adv Musculoskelet Dis. 2021;13:1759720X211002595. doi:10.1177/1759720X211002595Hsu ST, Ponugoti A, Deaner JD, Vajzovic L.Update on retinal drug toxicities.Curr Ophthalmol Rep. 2021;9(4):168-177. doi:10.1007/s40135-021-00277-xDella Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA.Acute chloroquine and hydroxychloroquine toxicity: a review for emergency clinicians.Am J Emerg Med. 2020;38(10):2209-2217. doi:10.1016/j.ajem.2020.07.030
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shippey EA, Wagler VD, Collamer AN.Hydroxychloroquine: an old drug with new relevance.Cleve Clin J Med. 2018;85(6):459-467. doi:10.3949/ccjm.85a.17034American Osteopathic College of Dermatology.Hydroxychloroquine.Yusuf I, Sharma S, Luqmani R, Downes SM.Hydroxychloroquine retinopathy.Eye (Lond).2017;31(6):828–845. doi:10.1038/eye.2016.298Corradetti G, Violanti S, Au A, Sarraf D.Wide field retinal imaging and the detection of drug associated retinal toxicity.Int J Retina Vitreous. 2019;5(Suppl 1):26. doi:10.1186/s40942-019-0172-0Ahn SJ, Lee BR.Hydroxychloroquine retinopathy update.J Rheum Dis. 2018;25(3):153-157. doi:10.4078/jrd.2018.25.3.153Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF;American Academy of Ophthalmology. recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision).Ophthalmology. 2016;123(6):1386-1394. doi:10.1016/j.ophtha.2016.01.058Muller R.Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities.Rheumatol Int. 2021;41(7):1189-1202. doi:10.1007/s00296-021-04868-6Lin T, Marmor MF, Barbhaiya M, et al.Baseline retinal examinations in patients with systemic lupus erythematosus newly initiating hydroxychloroquine treatment in a US Medicaid systemic lupus erythematosus population, 2000–2010.Arthritis Care Res. 2018;70(11):1700-1706. doi:10.1002/acr.23530Petitdemange A, Felten R, Sibilia J, Martin T, Arnaud L.Prescription strategy of antimalarials in cutaneous and systemic lupus erythematosus: an international survey.Ther Adv Musculoskelet Dis. 2021;13:1759720X211002595. doi:10.1177/1759720X211002595Hsu ST, Ponugoti A, Deaner JD, Vajzovic L.Update on retinal drug toxicities.Curr Ophthalmol Rep. 2021;9(4):168-177. doi:10.1007/s40135-021-00277-xDella Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA.Acute chloroquine and hydroxychloroquine toxicity: a review for emergency clinicians.Am J Emerg Med. 2020;38(10):2209-2217. doi:10.1016/j.ajem.2020.07.030
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Shippey EA, Wagler VD, Collamer AN.Hydroxychloroquine: an old drug with new relevance.Cleve Clin J Med. 2018;85(6):459-467. doi:10.3949/ccjm.85a.17034American Osteopathic College of Dermatology.Hydroxychloroquine.Yusuf I, Sharma S, Luqmani R, Downes SM.Hydroxychloroquine retinopathy.Eye (Lond).2017;31(6):828–845. doi:10.1038/eye.2016.298Corradetti G, Violanti S, Au A, Sarraf D.Wide field retinal imaging and the detection of drug associated retinal toxicity.Int J Retina Vitreous. 2019;5(Suppl 1):26. doi:10.1186/s40942-019-0172-0Ahn SJ, Lee BR.Hydroxychloroquine retinopathy update.J Rheum Dis. 2018;25(3):153-157. doi:10.4078/jrd.2018.25.3.153Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF;American Academy of Ophthalmology. recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision).Ophthalmology. 2016;123(6):1386-1394. doi:10.1016/j.ophtha.2016.01.058Muller R.Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities.Rheumatol Int. 2021;41(7):1189-1202. doi:10.1007/s00296-021-04868-6Lin T, Marmor MF, Barbhaiya M, et al.Baseline retinal examinations in patients with systemic lupus erythematosus newly initiating hydroxychloroquine treatment in a US Medicaid systemic lupus erythematosus population, 2000–2010.Arthritis Care Res. 2018;70(11):1700-1706. doi:10.1002/acr.23530Petitdemange A, Felten R, Sibilia J, Martin T, Arnaud L.Prescription strategy of antimalarials in cutaneous and systemic lupus erythematosus: an international survey.Ther Adv Musculoskelet Dis. 2021;13:1759720X211002595. doi:10.1177/1759720X211002595Hsu ST, Ponugoti A, Deaner JD, Vajzovic L.Update on retinal drug toxicities.Curr Ophthalmol Rep. 2021;9(4):168-177. doi:10.1007/s40135-021-00277-xDella Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA.Acute chloroquine and hydroxychloroquine toxicity: a review for emergency clinicians.Am J Emerg Med. 2020;38(10):2209-2217. doi:10.1016/j.ajem.2020.07.030
Shippey EA, Wagler VD, Collamer AN.Hydroxychloroquine: an old drug with new relevance.Cleve Clin J Med. 2018;85(6):459-467. doi:10.3949/ccjm.85a.17034
American Osteopathic College of Dermatology.Hydroxychloroquine.
Yusuf I, Sharma S, Luqmani R, Downes SM.Hydroxychloroquine retinopathy.Eye (Lond).2017;31(6):828–845. doi:10.1038/eye.2016.298
Corradetti G, Violanti S, Au A, Sarraf D.Wide field retinal imaging and the detection of drug associated retinal toxicity.Int J Retina Vitreous. 2019;5(Suppl 1):26. doi:10.1186/s40942-019-0172-0
Ahn SJ, Lee BR.Hydroxychloroquine retinopathy update.J Rheum Dis. 2018;25(3):153-157. doi:10.4078/jrd.2018.25.3.153
Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF;American Academy of Ophthalmology. recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision).Ophthalmology. 2016;123(6):1386-1394. doi:10.1016/j.ophtha.2016.01.058
Muller R.Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities.Rheumatol Int. 2021;41(7):1189-1202. doi:10.1007/s00296-021-04868-6
Lin T, Marmor MF, Barbhaiya M, et al.Baseline retinal examinations in patients with systemic lupus erythematosus newly initiating hydroxychloroquine treatment in a US Medicaid systemic lupus erythematosus population, 2000–2010.Arthritis Care Res. 2018;70(11):1700-1706. doi:10.1002/acr.23530
Petitdemange A, Felten R, Sibilia J, Martin T, Arnaud L.Prescription strategy of antimalarials in cutaneous and systemic lupus erythematosus: an international survey.Ther Adv Musculoskelet Dis. 2021;13:1759720X211002595. doi:10.1177/1759720X211002595
Hsu ST, Ponugoti A, Deaner JD, Vajzovic L.Update on retinal drug toxicities.Curr Ophthalmol Rep. 2021;9(4):168-177. doi:10.1007/s40135-021-00277-x
Della Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA.Acute chloroquine and hydroxychloroquine toxicity: a review for emergency clinicians.Am J Emerg Med. 2020;38(10):2209-2217. doi:10.1016/j.ajem.2020.07.030
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