Plaquenil Toxicity

Early on, there may be no symptoms at all – the eye can be undergoing damage with no obvious change in vision. This is why regular eye check-ups are crucial. As toxicity develops, a person may experience one or more of the following symptoms:

• Blurry or reduced vision clarity: You might notice your vision isn’t as sharp as it used to be, making it hard to see fine details. This can affect activities like reading or recognizing faces.
• Blank spots in the central vision: Some people develop small blank or dark spots in their sight, often near the center. These blind spots (called paracentral scotomas) can make it difficult to read or see objects you are looking at directly.
• Distorted vision (straight lines look wavy): You may find that straight lines – like door frames or lines of text – appear bent or wavy. This type of distortion (known as metamorphopsia) is a sign of retinal damage.
• Trouble seeing colors, especially red: Plaquenil toxicity can cause colors to appear faded. In particular, you might have difficulty distinguishing red objects or they may look duller than before.
• Sensitivity to light (photophobia): Your eyes might become more sensitive to bright light. You could experience glare or discomfort in brightly lit environments, and sunlight or headlights might bother you more than they used to.
• Halos or rings around lights: Some people notice glowing rings or “halos” around light sources (like streetlights or car headlights), especially at night. This often happens when there are deposits on the cornea (front of the eye) due to the medication.
• Seeing flashing lights or flickers: You might see brief flashes of light or flickering in your vision that aren’t actually there. These “sparkles” or flickers of light can occur in the central vision as the retina becomes affected.
• Difficulty reading or focusing on words: Even if you can see the eye chart clearly, you may find it harder to read books or look at text up close. Some patients report needing more light to read or that words seem to disappear due to the vision changes.
• Poor night vision: In later stages, you might have trouble seeing in dim light or darkness. For example, going from a bright room into a dark room (or night driving) might become much harder because your vision doesn’t adjust well.

These symptoms usually affect both eyes at the same time (since the drug impacts the retina in both eyes similarly). Keep in mind that symptoms often do not appear until damage has already started, so don’t wait for symptoms to get an eye exam if you are on Plaquenil.

Plaquenil can cause a condition known as hydroxychloroquine retinopathy (or Plaquenil toxicity). In this condition, the medication slowly damages the retinal cells, particularly in the macula (the central area of the retina that you use for reading and seeing fine details). Early on, there may be no noticeable effect because the damage often starts in a ring around the very center of the macula. As toxicity advances, it creates a characteristic pattern of damage on the retina. Doctors often refer to this as a “bull’s-eye maculopathy,” because the damaged area forms a ring around the healthier center – almost like a target or bull’s-eye shape on the retina. In simple terms, Plaquenil toxicity can make parts of the retina stop working properly, especially near the center, which is critical for clear vision.

Importantly, retinal damage from Plaquenil is usually permanent. If the drug has harmed the retina, the vision loss may be irreversible – stopping the medication does not always fix the damage that’s already done. In fact, in some cases the vision can continue to worsen for a time even after the drug is discontinued. This is why catching any signs of toxicity early is critical.

Hydroxychloroquine retinopathy is an eye condition where the medication hydroxychloroquine (brand name Plaquenil) causes damage to the retina – the light-sensitive layer at the back of the eye that is crucial for vision. This damage (also called retinal toxicity) happens typically after long-term use of hydroxychloroquine. In some patients, the drug can build up in the retina and harm the cells, leading to vision problems or even permanent vision loss. Although hydroxychloroquine is very effective for treating certain diseases (like lupus and rheumatoid arthritis), about 7.5% of people who take it eventually show signs of retinal damage, and this risk increases to roughly 20% (1 in 5 people) after 20 years of use.

• Why it Happens: Taking hydroxychloroquine at high doses or for many years raises the risk of retinopathy. The medication can slowly accumulate in the retina and disrupt the function of retinal cells. Usually, using the drug for under 5 years (at recommended doses) has a very low risk (well under 1%) of causing retina damage. However, beyond 5 years of continued use, the chance of toxicity goes up substantially. For example, studies have found the risk is under 2% after 10 years, but nearly 20% after 20 years on the medication. Other factors like having kidney problems (which slow the drug’s removal from the body) or taking certain other medications (such as tamoxifen) can also increase the risk of hydroxychloroquine retinopathy.
• Effects on Vision: In early stages, hydroxychloroquine retinopathy may not cause any symptoms. People usually don’t notice any vision change at first, which is why the condition can sneak up unnoticed. As the damage worsens, patients might develop symptoms such as blurry or distorted vision, trouble reading, or missing spots in their central vision (like having blank or dark patches in the middle of what they see). Color vision might become less sharp, and in advanced cases a distinctive “bull’s-eye” pattern of damage appears in the retina. (Eye doctors call it bull’s-eye maculopathy because the damaged area forms a ring around the center of the retina, looking like a target.)
• Severity and Permanence: If hydroxychloroquine retinopathy progresses to a late stage, it can cause serious and irreversible vision loss – especially when the central retina (the macula, responsible for detailed vision) is affected. In fact, once significant retinal damage has occurred, stopping the medication will not reverse the vision loss. The vision loss can even continue to worsen for some time after the drug is discontinued. This is why doctors are very cautious about monitoring patients on hydroxychloroquine.
• Prevention and Screening: Early detection of hydroxychloroquine retinopathy is critical. The American Academy of Ophthalmology (AAO) and other medical groups recommend regular eye exams for patients on this medication. Typically, a patient will get a baseline eye exam around the start of treatment, and annual retinal screenings after 5 years of continuous use (sooner if there are higher risk factors). During these exams, eye doctors perform special tests (like retina scans and visual field tests) to catch the very first signs of retinopathy before the person notices any vision change. Detecting the problem early and stopping the drug can prevent severe damage. It’s important to note that there is no treatment to reverse hydroxychloroquine retinopathy once it has begun, so prevention and early detection are the best strategies.

Hydroxychloroquine retinopathy is damage to the eye’s retina from long-term hydroxychloroquine use. It is a rare side effect of a beneficial medication, but it can lead to permanent vision loss if not caught early. Patients taking hydroxychloroquine should be aware of this risk and follow their ophthalmologist’s recommendations for regular eye check-ups. With proper dosing and screening, the risk of serious eye damage is low, and most people can continue to benefit from the medication safely under medical supervision.

For most people on Plaquenil, eye toxicity develops very slowly over time. It typically takes many years of continuous use before any serious retinal damage is likely to occur. According to studies and expert guidelines (including the American Academy of Ophthalmology), the risk of retinal toxicity remains very low in the early years of treatment and then increases with longer use:

• First 5 years of use: Under 1% chance of retinal toxicity (very low risk). In other words, fewer than 1 out of 100 patients on safe doses develop eye damage in this period.
• After 10 years: Approximately 2% chance of toxicity by the 10-year mark. The vast majority (98 out of 100) still do not have retinal damage at ten years when taking recommended doses.
• After 20 years or more: The risk rises significantly – about 20% (1 in 5) of long-term users may show signs of retinal toxicity after 20 years. This means long-term Plaquenil use (two decades or longer) has a higher chance of affecting the eyes.

It’s worth noting that individual experiences can vary. In extremely rare cases, some patients have shown signs of retinal toxicity earlier than expected (there have been a few reports of eye changes in less than a year of use). However, such early-onset toxicity is highly unusual. Generally, if the medication is dosed correctly and risk factors are managed, significant toxicity is unlikely to develop in the first few years of therapy.

Plaquenil (hydroxychloroquine) can sometimes cause serious eye-related side effects if taken in high doses or for a long time. The most significant issue is retinal damage (to the light-sensitive tissue at the back of the eye). This retinal toxicity is often called bull’s-eye maculopathy because doctors may see a bull’s-eye ring pattern in the macula (center of the retina) during an eye exam. Retinal damage can lead to permanent vision loss – even after the medication is stopped – if it is not caught early. Plaquenil can also affect other parts of the eye: it may cause deposits in the cornea (the clear front of the eye) or rarely affect the ciliary body (the eye’s focusing muscle), though these are less common and usually not as severe.

Symptoms of Plaquenil eye toxicity can include:

• Blurry or distorted vision: Vision may become fuzzy, and straight lines might appear bent or wavy. People often have trouble reading or seeing fine details because their central vision is affected.
• Blind spots in the field of vision: Some patients develop small blank or dark spots near the center of their vision (called paracentral scotomas). This makes it hard to read or see objects directly ahead. Over time, these spots can widen, leading to areas of vision loss.\
• Color vision changes: Colors may appear faded or different than normal (for example, difficulty distinguishing certain colors, like red).
  Light sensitivity and glare: Plaquenil toxicity can make eyes more sensitive to bright light. Patients might see increased glare or even halos (rings) around lights, especially at night.
• Difficulty with night vision: Some people have trouble seeing in dim light or darkness (poor night vision) because of retinal damage.
• Rare focusing problems: In uncommon cases, Plaquenil affects the eye’s focusing ability. This can cause difficulty seeing things up close, making tasks like reading small print harder.

Not everyone who takes Plaquenil will have eye side effects, but these problems become more likely with long-term use or higher doses. According to the American Academy of Ophthalmology, retinal toxicity is irreversible and may even continue to worsen after the drug is discontinued. For this reason, eye doctors strongly recommend regular eye exams for anyone taking Plaquenil to catch any early signs of toxicity before serious damage occurs. Staying at or below the recommended dose (no more than 5 mg per kilogram of body weight per day) also helps lower the risk of eye damage.

Plaquenil (generic name hydroxychloroquine) can cause damage to the retina (the light-sensing layer at the back of the eye) when used for a long time. This retinal damage is permanent (irreversible) and can lead to vision loss if not caught early. Eye doctors use a special imaging test called OCT (optical coherence tomography) to detect early signs of Plaquenil toxicity in the retina. An OCT scan is like a detailed cross-sectional picture of the retina, showing its layers. In Plaquenil toxicity, the OCT will reveal characteristic changes: mainly a thinning (loss of thickness) of certain retinal layers in a ring around the center of the retina (the macula). In other words, the retina tissue just outside the very center of vision becomes thinner or atrophied due to the drug, often forming a ring of damage (much like a bull’s-eye target pattern around the central spot). The central part of the macula (fovea) often remains relatively intact early on, while the surrounding area shows this loss of retinal tissue. On the cross-sectional OCT image, this creates a distinct shape that eye doctors sometimes refer to as the “flying saucer” sign – because the healthy center area looks elevated next to the depressed (thinner) areas around it, resembling a saucer shape. As damage progresses, the ring of thinning becomes more pronounced and corresponds to the classic “bull’s-eye” pattern seen on regular retinal exams in advanced Plaquenil toxicity. These OCT findings help doctors recognize Plaquenil toxicity early, often even before a patient notices vision changes, so that the medication can be stopped to prevent further retinal damage.

A visual field test is a simple, painless exam to check your field of vision (both central and peripheral sight). During this test, you sit down and look straight ahead into a bowl-shaped machine. Small lights will flash one at a time at different spots inside the bowl. Whenever you see a light flash, you quickly press a response button. You keep looking at the center target the whole time, which lets the machine map out the full area you can see. The machine records which lights you noticed and which you missed. By doing this, it creates a map of your vision and shows if there are any blind spots or weak areas in your sight. If Plaquenil has begun to harm the retina, the test might reveal small missing areas in your vision (for example, spots near the center of your gaze) even before you notice them yourself. The visual field test usually takes only a few minutes per eye and does not hurt. It helps your eye doctor find early signs of Plaquenil toxicity so that steps can be taken to protect your vision.

Most doctors recommend getting a baseline eye exam when you start Plaquenil (or within the first year). This initial exam often includes a detailed retina check, and sometimes tests like a visual field and OCT scan (an imaging test of the retina) if you have any existing eye issues. After several years on Plaquenil, regular screening becomes very important. According to the American Academy of Ophthalmology guidelines, if you have been on Plaquenil for 5 years or more, you should have a visual field test (and other retinal exams) every year to monitor for toxicity. Some people may need to start yearly tests even earlier than 5 years if they have higher risk for eye damage. Risk factors that increase the chance of Plaquenil toxicity (and might prompt earlier or more frequent testing) include:

• Long-term use: Taking Plaquenil for 5 years or longer. The risk of retinal damage is very low in the first five years (under 1%), but it rises with longer use.
• High dosage: Taking a higher dose of Plaquenil than recommended for your body weight. Doses above about 5 mg per kilogram of body weight per day increase toxicity risk.
• Older age: Being over 60 years old. Aging eyes may be more susceptible to drug-related damage.
• Kidney or liver disease: Having kidney or liver problems. These conditions can slow the clearing of the drug from your body, leading to higher drug levels in the eye.
• Pre-existing eye disease: Having an existing retinal or macular disease. An unhealthy retina might be more vulnerable, and it can also make test results harder to interpret.
• Significant weight loss: Losing a lot of weight while on Plaquenil. This could make your fixed dose effectively too high for your new weight, so your doctor might adjust your dose to a safer level.

If you have any of these risk factors, your ophthalmologist (eye doctor) might start annual visual field tests earlier than the 5-year mark, or even perform additional types of eye tests to be safe. By following the recommended screening schedule, doctors can catch the very first signs of Plaquenil toxicity in most cases. This way, the medication can be stopped before significant vision loss occurs. Remember, the visual field test is one of the best tools to protect your eyesight while you benefit from Plaquenil’s treatment effects. It is quick and easy, and it provides valuable information to ensure your eyes stay healthy.

• Retinal Damage and Vision Loss: Long-term Plaquenil use can cause toxic retinopathy, meaning the drug harms the retina. This is rare in early years of use, but the risk increases the longer you take the medication. Over many years, a small percentage of patients can develop retinal damage – for example, about 7.5% of people on Plaquenil show signs of retinal toxicity, and this rises to roughly 20% (1 in 5 people) after 20 years of treatment. When the retina is damaged, vision becomes blurry or distorted. People may develop a blind spot in the center of their vision or have trouble reading and recognizing faces. This condition is sometimes called “bull’s-eye maculopathy” because eye doctors see a ring of damage in the retina that looks like a target or bull’s-eye pattern. In advanced cases of toxicity, Plaquenil can cause loss of sharp central vision, loss of peripheral (side) vision, and poor night vision. In other words, a person might have difficulty seeing things in front of them clearly, trouble seeing objects off to the side, and difficulty seeing in dim light or darkness.
• Permanent and Progressive Vision Changes: Plaquenil-related eye damage is often permanent. According to the American Academy of Ophthalmology, even if the medication is stopped, any vision loss from Plaquenil toxicity may be irreversible and may continue to progress. This means that once the retina is injured, the vision might not return to normal. In fact, some patients’ vision can keep getting worse for a time even after the drug is discontinued. (Plaquenil can linger in retinal tissue, causing ongoing damage.) This is why doctors stress the importance of regular eye exams for people taking Plaquenil long-term – catching any early signs of toxicity can help prevent severe damage. If retinal toxicity is detected early and the drug is stopped, further damage can often be prevented, but existing vision loss usually cannot be reversed.
• Other Long-Term Effects (Rare): Plaquenil is generally considered safe for most people, and serious long-term side effects are uncommon. The eye issues are the main concern. However, in rare cases Plaquenil can also affect other parts of the body after long-term use. For example, it can sometimes cause heart problems (affecting the heart muscle or rhythm). It can also, very rarely, cause muscle weakness or nerve damage leading to tingling or loss of strength in the arms or legs. These non-eye effects are much less common than retinal toxicity, but doctors may still monitor for them (for instance, with occasional heart check-ups, blood tests, or muscle strength tests). Fortunately, if these rare problems are caught early and Plaquenil is stopped, they often improve or resolve over time.

The long-term effect of Plaquenil toxicity most often refers to eye damage that can cause permanent vision loss. This damage can manifest as blurry vision, blind spots (especially in the center of vision), and difficulty seeing at night or to the sides. Crucially, retinal damage from Plaquenil is usually irreversible, and in some cases it may continue to worsen even after the drug is discontinued. Because of this, medical experts (including the American Academy of Ophthalmology) recommend regular eye screenings for anyone on long-term Plaquenil therapy to catch toxicity early. By staying within recommended doses and having routine eye exams, patients and doctors can work together to prevent serious long-term effects and keep the eyes healthy while benefiting from Plaquenil’s treatment effects.

• Rare in Early Years: According to expert guidelines, at proper dosages fewer than 1 out of 100 people (under 1%) show any signs of retinal toxicity in the first 5 years of taking Plaquenil. Even after 10 years of treatment, the risk remains below 2%. This means the chance of eye damage is very low during the early years of therapy when recommended dosing and screening guidelines are followed.
• Long-Term Use Increases Risk: The risk of Plaquenil toxicity does rise with very long use. For example, about 1 in 5 people (approximately 20%) may show some signs of retinal damage after 20 years of continuous Plaquenil use. Because of this higher risk over decades, doctors are very cautious with long-term Plaquenil therapy. In many cases, they will regularly re-check whether continuing the medication is still necessary as the years go by.
• Proper Dosage Is Key: Taking the right dose of Plaquenil for your body weight is crucial to minimizing risk. Doctors typically prescribe the lowest effective dose and avoid giving more than the recommended amount (around 5 milligrams per kilogram of body weight per day). Staying at or below this recommended dose greatly reduces the chance of toxicity, whereas consistently taking higher daily doses (or having very long treatment durations) can increase the risk of eye damage. That’s why doctors carefully calculate the dose that is both safe and effective for each patient.
• Regular Eye Screenings: Because Plaquenil can affect the eyes without early warning symptoms, regular eye exams are essential for anyone taking this medication. Guidelines advise getting a thorough baseline eye exam when starting Plaquenil (usually within the first year of treatment). If that exam is normal and no high-risk factors are present, experts recommend annual eye exams after 5 years of being on Plaquenil. (Patients with additional risk factors, such as kidney problems or certain other medications, may need to start yearly check-ups sooner.) These exams typically include dilating the eyes and doing special tests – like visual field tests or detailed scans of the retina – to detect any early signs of damage. If any signs of toxicity are caught early, the doctor will stop Plaquenil to prevent serious vision loss. By following the recommended screening schedule, doctors can find even subtle changes before they worsen.

In summary, Plaquenil toxicity is uncommon – especially in the first several years of treatment – and it can be kept very low-risk by using Plaquenil responsibly. The American Academy of Ophthalmology emphasizes that patients should be informed about the risk, proper dose levels, and the importance of regular screening to prevent hydroxychloroquine toxicity. In practice, this means staying on the correct dose and getting the advised eye check-ups. By doing so, people who need Plaquenil for their health can continue to take it safely, with only a small chance of any serious eye damage.

According to the American Academy of Ophthalmology (AAO), if an eye doctor finds signs of Plaquenil toxicity, the first step is to stop Plaquenil immediately to prevent further damage. Below are the key treatment and management steps for Plaquenil toxicity:

• Immediate drug discontinuation: The most important action is to stop taking Plaquenil right away to limit any further retinal damage. In most cases, stopping the medication will prevent the eye condition from getting worse. However, because Plaquenil stays in the body for a long time, some eye damage might still continue to progress for a while even after stopping the drug.
• No cure for existing damage: There is no treatment to reverse the retinal damage that has already happened due to Plaquenil toxicity. In other words, any vision loss from Plaquenil toxicity is not reversible. This is why early detection is so critical – once damage is done, doctors cannot restore the lost sight.
• Regular monitoring and early detection: Preventing severe toxicity is key. Doctors urge anyone on Plaquenil to get regular eye exams to catch early signs of retinal changes before serious damage occurs. The AAO recommends a baseline eye exam in the first year of Plaquenil use and annual screenings after several years on the drug. Early detection of any retinal changes and stopping the drug in time are the only steps proven to protect your vision from permanent loss.
• Alternative medications for the underlying disease: Your other doctors (such as a rheumatologist or dermatologist) will work to switch you to a different treatment for your condition if Plaquenil is causing toxicity. This way, the original autoimmune disease (like lupus or arthritis) is still managed, but Plaquenil is avoided to protect your eyes. According to experts, finding an alternative therapy is important to prevent further retinal damage and vision loss.
• Vision rehabilitation and support: If Plaquenil toxicity has already caused vision loss, doctors will provide support to help you cope with reduced vision. While lost vision cannot be restored, you should be offered resources such as low-vision services and devices (for example, magnifiers or special glasses) to maximize your remaining sight. Eye specialists and rehabilitation programs can teach you ways to adapt and use aids that help you with daily tasks despite vision impairment.

In summary, Plaquenil toxicity is managed mainly by stopping the drug and preventing further damage. There is no direct cure to fix the retinal injury once it occurs. That’s why doctors focus on early detection through regular eye check-ups and on protecting the eyes by discontinuing Plaquenil at the first sign of toxicity. By catching the problem early and switching to other medications, patients can avoid severe permanent vision loss. If vision has been affected, supportive care and low-vision tools can help the person maintain the best possible quality of life despite the damage.

Plaquenil (hydroxychloroquine) is a medication that can sometimes cause damage to the eyes when used for a long time. Doctors and scientists do not yet fully understand exactly how Plaquenil harms the eye. However, research supported by medical experts (including the American Academy of Ophthalmology) has revealed a few key factors in its toxicity:

• Builds Up in the Retina: Plaquenil tends to collect in the retina, especially in a layer of cells called the retinal pigment epithelium (RPE). It binds to melanin, a pigment in those cells, and stays there for a long time. This buildup means higher concentrations of the drug in the eye over time.
• Interferes with Cell Function: Once Plaquenil accumulates in the RPE cells, it interferes with how these cells work. In particular, it makes it hard for the RPE cells to perform their “housekeeping” duties – like cleaning up waste products from the eye’s light-sensing cells (photoreceptors). As a result, waste material from photoreceptor cells builds up, and the normal metabolism of the retinal cells is disrupted.
• Damages Light-Sensing Cells: Over time, this process causes the retinal cells to become unhealthy and even die. The supporting RPE cells may degenerate or migrate out of place, and the photoreceptor cells (which allow us to see) are irreversibly lost. This damage to the retina leads to vision loss. Often, the harm begins in areas of the retina just outside the very center of vision, and if it progresses it can create a ring of damaged vision (sometimes called a “bull’s-eye” pattern). Once the retinal cells are damaged, the vision loss is usually permanent.
• Slow to Leave the Eye: Plaquenil is eliminated from the body very slowly. It can remain in the eye for months after a patient stops taking it. This means that retinal damage can continue to worsen even after the drug is discontinued. In other words, any toxic effects don’t stop right away when the medicine is stopped, because the drug is still in the eye tissue.

Because of these factors, eye doctors strongly recommend regular eye exams for anyone taking Plaquenil. Early detection of toxicity is critical – if doctors catch signs of damage early and the drug is stopped, it can help prevent severe vision loss. The American Academy of Ophthalmology, for example, has guidelines to screen patients on Plaquenil so that any retinal changes are spotted as soon as possible. This way, doctors can protect a patient’s central vision by acting before too much damage is done.

Plaquenil (hydroxychloroquine) can sometimes damage the retina (the light-sensitive layer at the back of the eye). Unfortunately, once this kind of eye damage (Plaquenil toxicity) has occurred, it cannot be reversed. In other words, any vision loss caused by Plaquenil is usually permanent. There is no treatment that can fix or restore the retinal damage after it happens. Even if the medication is stopped, the existing damage will not improve, and in some cases the condition might continue to get worse for a while after stopping the drug. This is because Plaquenil can stay in the body’s tissues (including the eyes) for a long time, so its effects may linger and cause further harm even after discontinuation.

Because Plaquenil-related eye damage is not reversible, early detection and prevention are very important. Doctors (including the American Academy of Ophthalmology) strongly recommend regular eye exams for anyone taking Plaquenil. These check-ups can catch early signs of retinal damage before symptoms appear. If signs of toxicity are found early – before serious damage has been done – stopping Plaquenil right away can help prevent severe vision loss. In fact, catching toxicity at an early stage (before the center of the retina is affected) can save your central vision from permanent loss. However, if the damage is discovered late (after vision problems have developed), that damage cannot be undone and may even progress after the drug is stopped. This is why regular eye screening and proper dosing are critical while taking Plaquenil: it’s the best way to protect your eyesight, since there is currently no way to reverse Plaquenil toxicity.

To diagnose Plaquenil-related eye damage, doctors will perform a comprehensive dilated eye exam and use several specialized tests. Here are some of the key tests used to find Plaquenil eye damage:

• Visual field test: You sit and look into a bowl-shaped machine where small lights flash in different areas. Every time you see a light, you press a button. This test checks for any blind spots or vision loss in your field of view. (Plaquenil damage often causes a ring-shaped blind spot in the center of your vision.)
• OCT scan (Optical Coherence Tomography): An OCT is a special imaging scan that creates a detailed, three-dimensional picture of the retina (the back of your eye). The eye doctor examines these cross-section images for early signs of thinning or damage in the retinal layers. This scan can reveal the classic “flying saucer” pattern of Plaquenil toxicity (where certain retinal layers are lost around the center).
• Retinal photographs: The doctor takes special photos of the inside of your eye. Certain imaging (like fundus autofluorescence) makes damaged areas of the retina light up as bright spots in the pictures. These photos help detect early changes that might not be visible in a regular exam.
• Electroretinogram (ERG): In some cases, an advanced test called a multifocal ERG is used. This test measures the electrical signals of your retina in response to light flashes to see how well the retinal cells are working. An ERG can uncover subtle functional problems in the macula (central retina) before obvious damage is seen, making it useful for early detection of Plaquenil toxicity.

If any signs of retinal damage are found, the doctor will advise stopping Plaquenil right away to prevent further vision loss. By using these tests on a regular basis, doctors can diagnose Plaquenil eye damage early and help protect your eyesight.

Plaquenil (hydroxychloroquine) is a medication used to treat certain autoimmune diseases like rheumatoid arthritis and lupus. It has helped many people, but in rare cases it can permanently damage the retina (the light-sensitive layer at the back of the eye) and cause irreversible vision loss. The good news is that the chance of serious eye damage is very low in the first few years of use if you follow medical guidelines. However, the risk increases with higher doses and long-term use (for example, under 1% risk in the first 5 years, rising to nearly 20% after 20 years of continuous use). Here are steps you can take to protect your eyes and reduce the risk of Plaquenil-related eye damage:

• Take Plaquenil exactly as prescribed (proper dosage): Always follow your doctor’s dosing instructions and do not take more than recommended. The safe dose is based on your body weight – doctors usually limit Plaquenil to about 5 mg per kilogram of your weight, up to a maximum of 400 mg per day. Taking a higher daily dose than this can increase the chance of retina damage, so using the lowest effective dose for the shortest necessary time is best. In short, do not exceed the dose your doctor prescribes, and talk to your doctor to make sure your dose isn’t too high.
• Get regular eye exams (screening): Frequent check-ups with an eye doctor are essential for anyone taking Plaquenil. The American Academy of Ophthalmology recommends a comprehensive dilated eye exam before or soon after starting Plaquenil to establish a baseline, and then annual eye exams after five years of use (or earlier if you have higher risk factors). These exams should include tests that can catch early signs of damage to your retina before you notice any symptoms. Early detection is key – if any issues are found, the drug can be stopped to prevent further damage. Do not skip your eye appointments, even if your vision seems fine, because Plaquenil can cause damage before you feel any change.
• Know and discuss your risk factors: Certain factors can make Plaquenil-related eye damage more likely. These include being older (over 60 years old), taking Plaquenil for more than 5 years, having kidney or liver disease, or already having an eye condition (especially retinal or macular problems). If any of these apply to you, tell your doctor. You may need closer monitoring or earlier and more frequent eye exams. Your doctor might adjust your Plaquenil dose or screen your eyes sooner to stay safe. Always keep your healthcare providers informed about any other medications you take and any major changes in your health (for example, significant weight loss while on Plaquenil), since these can affect your risk as well.
• Monitor your vision and report changes: Pay attention to your eyesight while on Plaquenil. Do not ignore any changes in vision. If you notice problems like blurriness, difficulty reading, missing or dark areas in your sight, changes in color vision, or trouble seeing at night, report these to your eye doctor right away. Early detection of any vision change is critical – catching possible toxicity early gives the best chance to prevent permanent damage. Remember, if retinal damage is caught early (before it progresses), stopping the medication can usually prevent it from getting worse.

By following these precautions – taking the correct dose, getting the recommended eye exams, being aware of risk factors, and watching for vision changes – you can greatly lower the risk of Plaquenil eye damage. Plaquenil is very helpful for many conditions, and with proper use and monitoring, serious eye side effects are rare. Always work closely with your doctor and eye specialist to ensure you stay safe while benefiting from your medication.