She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Retinal toxicity associated with hydroxychloroquine and chloroquine Plaquenil prescribed by rheumatologist cut in half Plaquenil lichen planus Plaquenil and nerve damage There is a bull’s eye pigment irregularity in the macula. OS Vertical C/D ratio is 0.1. There is posterior vitreous separation. There is a mild bull’s eye pigment irregularity in the macula. SPECTRALIS-SD-OCT SCAN The OCT scan shows typical Plaquenil toxicity without retinal atrophy and a circle around the macula. Definition Bull’s eye maculopathy describes a number of different conditions in which there is a ring of pale-looking damage around a darker area of the macula. The macula can often appear to have circular bands of different shades of pink and orange. Age of onset and severity of sight loss varies, and it can be Nov 01, 2015 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. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Oct bull ey macula ellipsoid plaquenil Hydroxychloroquine Plaquenil Toxicity and., Bull's Eye Maculopathy – Causes, Complications, and. Why does hydroxychloroquine cost so muchMethotrexate plaquenil combinationBaseline testing for plaquenil Of course the aim is avoid drug related retinal toxicity, which on ophthalmic examination, appears as the classic Bull’s eye change affecting the macula. Once retinal toxicity from hydroxychloroquine occurs, it is thought that the retinal changes are permanent and the disease can progress even if hydroxychloroquine is stopped for 1 to 3 years. My Take on New Ocular Screening Guidelines for Plaquenil.. Retinal Physician - Hydroxychloroquine Maculopathy An Update.. Bull’s eye maculopathy Macular Society. 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. Bull’s-eye changes 5/84 400 RA 7 Blind area 20/30, 20/50 Reduced Enlarged blind spots. ultra–high-resolution optical coherence tomography allows for detailed visualization of the retinal structure on the level of individual retinal layers. corroborated by our findings in which hsUHR-OCT showed abnormalities of the outer retinal. Bull's-eye maculopathy due to hydroxychloroquine toxicity. Contributor Jesse Vislisel, MD Photographer Randy Verdick, FOPS September 9, 2013. This patient took hydroxychloroquine for rheumatoid arthritis and her vision dropped to 20/300 as a result of the retinal toxicity.