Plaquenil, or hydroxychloroquine, is a medication that is used for many autoimmune conditions, but it may have serious side effects in the eyes that affect vision.
Conditions that are Treated with Plaquenil
Many autoimmune conditions may require treatment with Plaquenil for the anti-inflammatory actions from the medication.
Systemic lupus erythematosus, rheumatoid arthritis, and sarcoidosis are three of the most common conditions which are treated with Plaquenil.
Potential Hydroxychloroquine Side Effects
There are various side effects which have been associated with Plaquenil. Among these potential side effects are nausea, vomiting, and headaches.
More severe side effects include bleeding, confusion, and changes to vision.
Eye Effects from Plaquenil
With prolonged treatment, the risk of Plaquenil retinal toxicity increases yearly.
The retinal toxicity includes a change in a ring-shaped pattern around the center of vision. This pattern is only seen with toxicity from medications such as Plaquenil.
In addition to a ring-shaped defect in vision, the retinal toxicity may lead to glare around lights or halos.
As the retinal toxicity progresses and becomes more advanced, it may lead to a decrease in the central vision.
Any of these changes to the retina or to vision are likely to be permanent.
How to Monitor for Plaquenil Toxicity
Since any changes from Plaquenil toxicity are permanent, it is important to monitor the for the development of the condition rather than wait until symptoms arise from it developing later.
It is recommended that anyone using Plaquenil have an annual dilated eye examination with their eye doctor.
Additionally, at the beginning of treatment with Plaquenil it is also recommended that several additional tests are performed for a baseline comparison.
The additional tests which are recommended are a central visual field test, an OCT laser scan of the macula, and a photograph of the retina with autofluorescence.
The central visual field test and macular OCT are performed every five years or more frequently if symptoms arise.
The visual field and macular OCT are used to detect early changes in the function of the retina. These changes may demonstrate the classic ring-shaped defect before it is visible in an eye examination or by your eye doctor.
The photograph of the retina with autofluorescence is used to detect physiological changes to the retina which are not yet creating any true defect or symptoms.
How is Hydroxychloroquine Toxicity Managed?
Monitoring for Plaquenil toxicity is necessary as any and all changes to vision or the eyes are likely permanent, however, if these changes can be detected early, it can be managed or mitigated.
By following up with your eye doctor, any changes due to Plaquenil toxicity should be identified early and before any loss of vision.
Once early changes due to Plaquenil are detected, your eye doctor and your rheumatologist or primary care doctor will discuss options including discontinuing Plaquenil, changing the dose of the Plaquenil, or increasing the frequency of tests to monitor for more changes.
A plan will be made by your team of doctors that is specific to your circumstances and situation.