Stop HCQ OCT Toxicity — SCE Rheumatology MCQ
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Correct answer: E — Recommend stopping hydroxychloroquine and urgently review alternative systemic therapy
Corresponding abnormalities on OCT and fundus autofluorescence satisfy the RCOphth (2020 revision) definition of definite hydroxychloroquine retinopathy. The ophthalmologist should recommend cessation to the prescribing clinician, prompting urgent discussion with the patient about the systemic risks of withdrawal and suitable alternative therapy. Toxicity is irreversible and may progress after withdrawal, particularly when more advanced, so early cessation protects vision. Chloroquine is not a safe substitute because it carries a greater retinal risk. Continuing hydroxychloroquine is appropriate only while an isolated ('possible') structural abnormality is undergoing confirmatory testing, not once definite toxicity is established. Dose escalation is dangerous because retinopathy risk is dose- and duration-dependent. Ignoring findings because she is asymptomatic defeats the purpose of screening, which exists to detect presymptomatic disease before irreversible foveal damage occurs.
Reference: The Royal College of Ophthalmologists recommendations on monitoring for hydroxychloroquine and chloroquine users in the United Kingdom (2020 revision): executive summary. Eye (Lond) 2021. https://pubmed.ncbi.nlm.nih.gov/33423043/