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. Hydroxychloroquine 200 mg side effects Chloroquine for malaria in pregnancy Plaquenil and dementia Patients who are receiving Plaquenil need to have a yearly ocular examination beginning at least within 5 years of starting therapy, including a dilated retinal examination, central visual field testing, and OCT scanning. The drug is usually discontinued at the earliest sign of macular damage since vision loss is usually permanent and can. Most rheumatologists recommend patients undergo a baseline eye examination prior to starting Plaquenil and be re-examined in the future depending on their risk for developing the condition. Risk factors include advanced age and having pre-existing retinal disease. The side effect that is of greatest concern is retinal toxicity. Retinal toxicity of Plaquenil may manifest itself with subtle disturbances of the retinal pigment epithelium which may eventually lead to complete destruction of the macula in the form of bull’s-eye maculopathy. 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. Plaquenil dilated eye retinal exam Plaquenil Eye Exams - Catalina Eye Care, Plaquenil Side Effects on Your Eyes and Vision Hydroxychloroquine sulfate pain killer After the surgery, the blind area was more noticeable because my sight in that eye was so much clearer,” she says. “The surgeon sent me to a retina specialist, who recommended that I cut down my dose of Plaquenil. Finally, my rheumatologist recommended that I stop taking the drug altogether.” Protecting your eyesight when taking Plaquenil Lupus Foundation of.. The Risk of Retinal Toxicity with Plaquenil - Sjogren's. Dialated Eye Exam Purpose, Procedure, Risks, Recovery. On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful. Retinal imaging allows eye doctors to see signs of eye diseases that they couldn’t see before. The test itself is painless and the results are easy for doctors to interpret. Your doctor can store the images on a computer and compare them with other scans. Furthermore, the advent of novice sensitive diagnostic modalities has led to a revision of the recommended guidelines for patients using Plaquenil see “2011 Plaquenil Screening Tests”. 7. A dilated fundus examination is critical in detecting and documenting established macular or retinal disease; however, due to low sensitivity, it should not be used as a screening test alone.