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HCQ Retinal Toxicity Cessation — RACP Adult Medicine MCQ

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ModerateRheumatologyHCQ Retinal Toxicity CessationRACP Adult Medicine

A 45-year-old woman on hydroxychloroquine for 10 years has OCT showing parafoveal thinning of the outer retinal layers (photoreceptor integrity line disruption) and visual field testing showing a ring scotoma. She is asymptomatic. What is the most appropriate management?

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Correct answer: A — Cease HCQ immediately — retinal toxicity detected

OCT showing parafoveal outer retinal thinning (photoreceptor disruption) with ring scotoma on visual field testing = early HCQ retinal toxicity (bull's eye maculopathy precursor). HCQ must be ceased IMMEDIATELY. Retinal toxicity is irreversible and can progress even after drug cessation (continuing retinal thinning from drug depot in retinal pigment epithelium). If SLE flares after HCQ cessation, alternative antimalarials are not available — manage with other DMARDs. This emphasises the importance of dose-based prevention (≤5 mg/kg).

Reference: RANZCO – 2024 – HCQ Toxicity; AAO 2024