Introduction Toxic hydroxychloroquine retinopathy is a well-known but uncommon complication of long-term hydroxychloroquine use. Patients are typically asymptomatic and retinal fundus examination is inadequate for detecting early retinal damage. Eye care providers should rely more heavily on objective testing to detect these early structural changes. Case Report A 48-year-old Asian male with systemic lupus erythematosus diagnosed 20 years prior and treated with hydroxychloroquine 400mg daily presented for his annual eye exam. Best corrected visual acuity was 20/20 in each eye, and the patient had no visual complaints. Dilated fundus examination was unremarkable, however spectral domain optical coherence tomography revealed focal loss of the ellipsoid zone line temporal to the fovea and inferior to the optic nerve in the right eye. After discussions with the patient’s rheumatologist and the ophthalmology retina service, the medication was discontinued. Conclusion Hydroxychloroquine retinopathy is a potentially vision threatening and progressive condition without any treatment. As such, the goal of every eye care provider should be to detect early structural retinal damage with objective testing preferred over subjective testing before retinopathy can progress to a bull’s eye pattern. Key words: automated visual fields, ellipsoid zone, hydroxychloroquine, optical coherence tomography
Gillett et al. (Thu,) studied this question.