Chloroquine and Hydroxychloroquine

  • Chloroquine prevents malaria
  • Hydroxychloroquine treats rheumatic illnesses
  • Most common ophthalmic side effect: damage to retinal pigment epithelium, causing irreversible vision loss
  • Retinal toxicity uncommon with chloroquine and even less common with hydroxychloroquine as long as proper dose limits observed
  • Ophthalmologic monitoring protects against severe toxicity
  • Blurred vision in both eyes
  • Pericentral scotomas on special visual fields
  • Fading of orange color of retina around fovea ("bull’s eye maculopathy"), appearing well after visual symptoms begin
  • Optical coherence tomography and multifocal electroretinography may reveal abnormalities before they are visible with ophthalmoscope and perhaps even before patient develops symptoms
  • Genetically-determined storage diseases
  • Healed choroiditis
  • Have patients treated with chloroquine undergo baseline ophthalmic examination and be monitored by ophthalmologist every 3-6 months after starting it
  • Have patients treated with hydroxychloroquine undergo baseline ophthalmic examination and be monitored yearly starting at 5 years of medication use
  • Keep chloroquine daily dose at <3 mg/kg/day and cumulative dose at <460 gm to reduce chances of retinopathy
  • Keep hydroxychloroquine daily dose at <6.5mg/kg/day and cumulative dose at <1000gm to reduce chances of retinopathy
  • Recognize that patients with renal failure are at unusually high risk of retinal toxicity
  • Stop medication at first suggestion of retinal toxicity
  • Chloroquine and hydroxychloroquine retinopathy rare if recommended dose limits followed
  • Once visual symptoms develop, they cannot be reversed, and may worsen even if medication stopped
  • Monitoring with visual fields, optical coherence tomography, and electroretinography allows earlier detection of toxicity and may prevent disabling vision loss