Hydroxychloroquine Vision Risks

Plaquenil (hydroxychloroquine) is a medicine used to treat juvenile arthritis, lupus, rheumatoid arthritis, sarcoidosis, Sjogren’s syndrome, Lyme disease, and other auto-immune diseases. It works by reducing swelling, joint damage, and pain. Side effects of the medication are rare but can cause vision changes such as: 

  • Central blind spot when reading or doing close work 
  • Blurry areas in central vision 
  • Worsening night vision 
  • Loss of peripheral vision 
  • Worsening visual acuity 

These vision changes may be due to Plaquenil toxicity. You may not notice symptoms in the early stages of toxicity. This is why it is important to have regular follow-ups with your ophthalmologist. We have tests that can detect subtle changes in the retina before serious problems arise. 

Even in early stages of Plaquenil toxicity, certain tests can detect changes to the retina. Your doctor may order a visual field test to determine if there are any blind spots in your vision that you may not notice. An optical coherence tomography (OCT) scan takes a quick cross-sectional view of the layers of the retina. This picture can show us subtle changes in the health of cells. An electroretinogram (ERG) is a test that measures the electrical activity of the structures of the eye and its ability to perceive light. All of these tests can be repeated over time to monitor for any changes or progression of vision symptoms. Your doctor will likely require a baseline test shortly after you start hydroxychloroquine therapy. Your ophthalmologist may have you return in 5 years following the start of your therapy, or annually if you’ve been on the medicine for longer.  

The main risk factor for developing hydroxychloroquine related eye disease is amount of dose taken. According to current guidelines, a dose range of greater than 5mg per kg of body weight is a risk factor. Other risks including using the medicine for more than five years, those 60 or older, have kidney or liver disease, are taking Tamoxifen, or have an underlying retina disease. 

These medicines have serious side effects and need to be prescribed by a doctor. Plaquenil is not FDA approved to treat Covid-19. Vision loss from Plaquenil toxicity is irreversible and can continue to progress even after stopping the medication, as it takes a long time for it to clear from the body. It is important to have regular exams with your retina specialist to monitor changes with dilated eye exams. Your ophthalmologist will be communicating with your rheumatologist to help determine the safest medicine for you to manage your arthritis symptoms. If are currently taking Plaquenil and would like an eye appointment, call us at (6160 954-2020.