skip to main content

HCQ Retinopathy Detection Action — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateChronic Kidney DiseaseHCQ Retinopathy Detection ActionESENeph

A 42-year-old woman with CKD G3a and SLE on Hydroxychloroquine develops macular oedema on routine ophthalmological screening at 6 years of HCQ use. Visual acuity is mildly reduced. What action is required?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stop HCQ immediately – macular changes on screening indicate early retinal toxicity; HCQ retinopathy is irreversible if exposure continues after detection

HCQ retinal toxicity is irreversible once established. The purpose of annual screening after 5 years (RCOphth 2020) is to detect early subclinical changes (parafoveal thinning on OCT, visual field defects) BEFORE symptomatic vision loss occurs. When screening detects abnormalities consistent with HCQ toxicity, the drug must be stopped immediately to prevent further progression. Once stopped, toxicity may still progress for a period (the drug has a long tissue half-life). The risk-benefit of HCQ continuation should be discussed with the rheumatology team.

Reference: RCOphth 2020 – HCQ Screening; KDIGO 2024 – Lupus Nephritis