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Hydroxychloroquine retinopathy — SCE Rheumatology MCQ

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HardRheumatological PharmacologyHydroxychloroquine retinopathySCE Rheumatology

A patient taking long-term hydroxychloroquine has reproducible parafoveal outer-retinal thinning on OCT and matching functional abnormalities. What is the appropriate next step?

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Correct answer: A — Confirm toxicity and discuss withdrawal with the prescriber

The best answer is “Confirm toxicity and discuss withdrawal with the prescriber”. Definite hydroxychloroquine retinopathy can progress and is not reversible, so ophthalmology should confirm the pattern and advise the prescribing team and patient; the prescriber then weighs cessation and alternative disease control. Dose escalation, waiting for acuity loss, chest imaging and glucocorticoids do not manage retinal toxicity.

Reference: Royal College of Ophthalmologists hydroxychloroquine retinopathy guideline: https://www.rcophth.ac.uk/resources-listing/2609/