What Is Bull’s-Eye Maculopathy?

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Bull’s-eye maculopathy is a term used to describe the appearance of a target's bull's-eye ring on a damaged retina, an essential part of the eye that helps with sight. This damage can be caused by different eye conditions or long-term use of certain drugs that suppress the immune system.

Bull's-eye maculopathy can appear at any age, and lead to mild or more serious vision loss that's usually irreversible.

This article provides an overview of bull's-eye maculopathy and the conditions that can cause it.

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Signs of Bull's-Eye Maculopathy

Bull's-eye maculopathy is not actually a diagnosis but rather a description of how the back of the eyeball looks when there's been damage from eye conditions or use of certain prescription medications.

To detect signs of bull's-eye maculopathy during an eye exam, a healthcare professional will look for:

  • Circles or rings of different shades of orange and pink on the retina
  • A darker center (like the bull's-eye on a dartboard or target) around the macula, which is located in the center of the retina

People experiencing damage to the retina and macula may notice signs, including vision changes, such as:

  • Blurred vision
  • Decreased vision
  • Difficulty reading
  • Glare
  • Flashes or streaks of light
  • Distorted vision
  • Diminished color vision 

Some people with bull's-eye maculopathy may not experience any symptoms at all, especially in the early stages. Over time, though, the damage can become more severe and eventually lead to vision loss.

Looking for Warning Signs

Bull's-eye maculopathy isn't something you can notice in the mirror. Instead, you'll need an eye examination to determine that it's there. Be aware of vision changes, though, such as no longer being able to read the time on a digital clock, losing color vision, or having trouble seeing at night. Contact an eye specialist, if accessible to you, for an examination and treatment.

Causes

There can be many different causes of bull’s-eye maculopathy, including conditions like:

  • Cone-rod dystrophies: A group of genetic disorders involving the eye cones (nerve cells located on the retina) can prompt bull’s-eye maculopathy and lead to legal blindness. 
  • Stargardt’s disease: Also called juvenile macular degeneration, this disease causes progressive damage to the macula. Vision loss can begin in childhood or the teenage years, but it usually does not cause complete blindness.
  • Batten disease: A rare and fatal disorder that affects the nervous system, Batten disease usually appears in children between the ages of 5 and 10 years old. Its earliest symptoms are usually vision related.
  • Benign concentric macular dystrophy: This rare genetic disorder causes a deterioration of the macula, eventually leading to vision loss.

Prescription drugs can also cause bull's-eye maculopathy in some cases. Hydroxychloroquine or chloroquine toxicity, when used in higher doses or for longer periods of time, can become toxic to the eyes and lead to bull's-eye maculopathy. These drugs are typically used to treat malaria and certain autoimmune diseases (like lupus and rheumatoid arthritis) and can cause irreversible damage to the retina and vision loss.

It's also possible for bull's-eye maculopathy to be present in people who do not have any of the above conditions. In these cases, experts do not know the exact cause, but it may be genetic. Many different types of maculopathies (a general term describing diseases that cause damage to the retina) are passed down from parent to child.

Diagnosis

Any damage to the macula will need to be diagnosed by a healthcare professional who specializes in treating eye conditions, such as an optometrist or ophthalmologist.

To detect bull's-eye maculopathy, they will perform tests such as:

  • Dilated eye exam: By temporarily dilating your eyes with eye drops to widen your pupil (the black, center part of your eye), the specialist is able to see the inner structures of your eye and get a magnified view of the retina.
  • Optical coherence tomography (OCT): OCT is similar to ultrasound testing, except that imaging is performed by using light waves rather than sound waves. It allows the specialist to look at and measure any changes to the retina.
  • Amsler grid: This grid allows specialists to measure how wide an area you can visualize away from a focal point. It can help point out any blind spots in your field of vision, and determine if you have vision loss.

Treatment

Currently, there’s no specific treatment for bull’s-eye maculopathy or the vision loss that's associated with it. For some people, the underlying disease and damage may have been progressing for years by the time the bull's-eye maculopathy becomes visible during an eye exam.

Experts recommend preventive care as the best treatment approach. This includes tips such as:

  • Getting routine eye exams
  • Reporting any vision changes to a healthcare provider
  • Monitoring your use of hydroxychloroquine or chloroquine, if applicable

Hydroxychloroquine Use

The American Academy of Ophthalmology recommends that anyone who has been prescribed hydroxychloroquine get an eye exam before starting the drug. A follow-up eye screening is recommended five years later, with yearly eye exams after that.

Prognosis

Each case of bull's-eye maculopathy is different, based on the underlying health condition that causes it and the extent of damage and vision loss that's occurred.

In most cases, people with bull's-eye maculopathy will likely experience some vision loss that doesn't improve, but they usually do not experience complete blindness. For people with bull's-eye maculopathy caused by hydroxychloroquine or chloroquine use, the vision loss can continue to worsen even after the medication is stopped.

Summary

Bull’s-eye maculopathy describes the appearance of damage on the retina that can result from different eye conditions or use of certain drugs that suppress the immune system. Bull's-eye maculopathy is only detectable during an eye exam. Its appearance is similar to a target's bull's-eye ring and is located at the back of the eyeball. It can appear at any age and cause mild or more severe vision loss that is usually not reversible.

A Word From Verywell

Regular eye exams are important for early detection of any eye or vision issues, including bull's-eye maculopathy. Contact a healthcare provider as soon as possible after any vision changes. While they may not be able to fully restore your vision, they will be able to monitor you for signs of further eye damage so that you can continue to live a safe and productive life.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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