Which statement is true regarding hydroxychloroquine’s ocular risk?

Which statement is true regarding hydroxychloroquine’s ocular risk?

• A. Renal failure
• B. Hepatic toxicity
• C. Peripheral neuropathy
• D. Retinal damage

Answer: (D)

Retinal damage from hydroxychloroquine is the principal ocular risk. With long-term use or a high cumulative dose, the drug can cause a dose- and duration-dependent retinopathy that starts in the parafoveal region and can progress to bull’s-eye maculopathy, risking irreversible loss of central vision. The mechanism involves the drug binding to melanin-containing retinal pigment epithelium and photoreceptors, disrupting lysosomal function and leading to degeneration of these cells. Because early changes can be silent, regular screening is essential: baseline eye exam, followed by OCT, fundus autofluorescence, and visual field testing to detect early macular involvement. Risk increases with higher daily dosing (generally >5 mg/kg real body weight) and with greater cumulative doses over time (long duration, such as several years), and is also higher in people with preexisting retinal disease or kidney impairment. Other ocular findings like corneal deposits can occur but are usually mild and reversible; retinal toxicity remains the serious, vision-threatening risk.

Retinal damage from hydroxychloroquine is the principal ocular risk. With long-term use or a high cumulative dose, the drug can cause a dose- and duration-dependent retinopathy that starts in the parafoveal region and can progress to bull’s-eye maculopathy, risking irreversible loss of central vision. The mechanism involves the drug binding to melanin-containing retinal pigment epithelium and photoreceptors, disrupting lysosomal function and leading to degeneration of these cells. Because early changes can be silent, regular screening is essential: baseline eye exam, followed by OCT, fundus autofluorescence, and visual field testing to detect early macular involvement. Risk increases with higher daily dosing (generally >5 mg/kg real body weight) and with greater cumulative doses over time (long duration, such as several years), and is also higher in people with preexisting retinal disease or kidney impairment. Other ocular findings like corneal deposits can occur but are usually mild and reversible; retinal toxicity remains the serious, vision-threatening risk.