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Hydroxychloroquine Retinopathy — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyHydroxychloroquine RetinopathySCE Rheumatology

A 65-year-old man with RA develops progressive visual deterioration. He has been on Hydroxychloroquine 400 mg daily for 12 years. Fundoscopy shows bilateral bull's-eye maculopathy. What is the prognosis for his vision?

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Correct answer: C — Vision may continue to deteriorate even after stopping Hydroxychloroquine

Bull's-eye maculopathy represents advanced Hydroxychloroquine retinopathy with significant photoreceptor and RPE damage. At this stage, the retinopathy is irreversible and may continue to progress even after drug withdrawal — a phenomenon attributed to ongoing retinal toxicity from drug stored in melanin-containing tissues. This underscores the importance of early detection through OCT screening before symptomatic visual loss occurs. RCOphth 2020 guidelines emphasise screening from year 5 to detect subclinical changes.

Reference: RCOphth 2020 HCQ retinopathy screening guideline; Marmor MF et al 2016 AAO revised screening recommendations