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Hydroxychloroquine retinopathy — SCE Rheumatology MCQ

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HardRheumatological pharmacologyHydroxychloroquine retinopathySCE Rheumatology

A long-term hydroxychloroquine user has parafoveal photoreceptor loss on OCT and a matching reproducible paracentral field defect. What should the rheumatology team do after ophthalmology classifies definite toxicity?

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Correct answer: C — Discuss hydroxychloroquine withdrawal and replace its SLE-control role

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

C is correct. Concordant structural and functional abnormalities support definite toxicity. Retinal damage can progress and is irreversible, so ophthalmology communicates the result and the prescriber discusses prompt withdrawal while preventing an SLE flare with an alternative plan. A waits for central damage. B extends exposure. D downgrades specialist monitoring. E substitutes a related retinotoxic drug.

Reference: Royal College of Ophthalmologists hydroxychloroquine retinopathy monitoring guideline: https://www.rcophth.ac.uk/wp-content/uploads/2020/12/Hydroxychloroquine-and-Chloroquine-Retinopathy-Monitoring-Guideline.pdf