Rare case of Hydroxychloroquine induced Retinal Toxicity reported

Dr.Cinthia Proano, at Watts Eye Associates, Newburyport, MA has reported a rare case of Hydroxychloroquine Retinal Toxicity. The case has appeared in the New England Journal of Medicine.

Many drugs may cause retinal toxicity and one such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine, a chloroquine derivative. It is used to treat many diseases including malaria, rheumatoid arthritis and systemic lupus erythematosus.

Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. It is imperative that patients and physicians are aware of and watch for this drug’s ocular side effects. And before treatment is initiated with hydroxychloroquine, a complete ophthalmic examination should be performed to determine any baseline maculopathy.

A 57-year-old woman presented for her annual ophthalmic evaluation. Her medical history was remarkable for diagnoses of systemic lupus erythematosus and Sjögren’s syndrome. She had been taking 400 mg of hydroxychloroquine daily for 8 years. Her ophthalmic history included a baseline visual acuity of 20/20 in each eye, normal color vision, and normal findings on automated visual field testing.

At year 8 of therapy, she reported no visual symptoms. Testing indicated that her color vision had diminished from baseline in both eyes. Standard achromatic perimetry revealed paracentral scotomas in each eye (Panel A [showing the left eye]), and macular spectral-domain optical coherence tomography revealed a loss of the retinal inner and outer segments (Panel B [showing the left eye], arrows), findings consistent with hydroxychloroquine retinal toxicity.

The results of slit-lamp and funduscopic examinations were normal. Long-term therapy with hydroxychloroquine is commonly used in the treatment of autoimmune diseases. Routine eye examination with appropriate ancillary testing should be considered for patients receiving long-term hydroxychloroquine therapy. In this case, the hydroxychloroquine treatment was stopped, and treatment with methotrexate was initiated by her rheumatologist.

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DOI: 10.1056/NEJMicm1304542