Plaquenil Vision Side Effects: Risks and Prevention

Stay informed and knowledgeable of the risks

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Plaquenil (hydroxychloroquine) is used to treat several inflammatory conditions as well as malaria, but you should be aware that Plaquenil side effects can affect your eyes and vision if you are taking it.

Plaquenil is in a class of drugs called disease-modifying anti-rheumatic drugs (DMARDs), which are used to decrease inflammation, pain, and joint damage. While today it is used to treat autoimmune conditions, such as rheumatoid arthritis and lupus, it was used first as an anti-malaria drug.

The eye-related side effects of Plaquenil are uncommon but severe enough to warrant paying extra attention to what's going on.

Man receiving an eye exam
Eric Audras / Getty Images

Hydroxychloroquine Retinopathy

In some people, Plaquenil can cause a condition called hydroxychloroquine retinopathy, often referred to as bulls-eye maculopathy. The condition can cause the appearance of a target, or bulls-eye ring, on the retina surrounding the macula. The retina is the tissue in the back of the eye that receives light; the macula is the area responsible for central vision.

Hydroxychloroquine retinopathy is extremely rare. It is most often seen in cases where the dosage is high or a person has been taking the drug for several years. When it does occur, Plaquenil side effects can be devastating to your vision.

Initially, central vision is not affected. You may notice a ring of disrupted vision that can interfere with reading.

As the disease progresses, it begins to affect central vision and can become life-altering. The changes caused by these Plaquenil side effects are permanent, so early detection of this condition is paramount.

Symptoms

If you have odd visual changes at any time while taking Plaquenil, see a healthcare provider. These changes may include blurry vision, circular patterns, or changes in how you see color.

Risk Factors

Taking Plaquenil for more than five years is a key risk factor but it is not the only one. Others include:

  • Older age
  • Pre-existing retinal disease
  • Female sex
  • Higher body mass index
  • Chronic kidney disease

The risk also rises when your cumulative dose (the total dose you've taken over time) reaches more than 600 grams.

Testing

Most rheumatologists recommend that people undergo a baseline eye examination prior to starting Plaquenil. Because retinal toxicity is much more likely after five to seven years, annual exams should start once you've been on the drug for five years.

Some healthcare providers favor more frequent testing to check for Plaquenil-related vision changes, including a full evaluation every 18-24 months during the first five years and annually thereafter.

Guidelines for Plaquenil screenings have expanded over the years and the technology for detecting retinal changes has improved. Currently, a Plaquenil eye exam should including the following:

  • Visual field test
  • OCT Imaging: three dimensional pictures of the eye
  • Multifocal ERG: examines the cells in the retina
  • Photos

Your healthcare provider may recommend frequent, simple at-home tests in addition to extra eye exams.

Summary

Plaquenil (hydroxychloroquine) offers benefits for many people who take the drug to treat inflammatory diseases, like lupus, or as an anti-malarial medication. Yet Plaquenil has side effects that may harm your eyes and vision in potentially serious and permanent ways.

The long-term use of Plaquenil increases the risk of a rare but severe condition called hydroxychloroquine retinopathy. It's for this reason that healthcare providers typically monitor people more closely when they have taken Plaquenil for more than five years.

Frequently Asked Questions

  • Can Plaquenil-related eye damage be reversed?

    No, but in some cases stopping the drug will limit the damage. This is why it's so important for people taking Plaquenil to be carefully monitored. Yet some researchers are finding new patterns of eye damage beyond the classic "bulls-eye ring" on the retina. They've also found that eye damage may progress even after stopping the drug, and that Plaquenil may still be present in your liver, kidneys, and other body tissues for quite some time.

  • Is it possible to overdose, or take too much Plaquenil?

    Yes, although there is no known or established level of hydroxychloroquine in adults that's considered toxic or lethal. That said, mild toxicity may occur at doses of less than 2 grams, moderate toxicity between 2 and 4 grams, and severe toxicity at levels greater than 4 grams. Doses over 5 grams may prove fatal because of electrolyte imbalances and impacts on heart function.

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11 Sources
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  1. Shippey EA, Wagler VD, Collamer AN. Hydroxychloroquine: An old drug with new relevanceCCJM. 2018;85(6):459-467. doi:10.3949/ccjm.85a.17034

  2. American Osteopathic College of Dermatology. Hydroxychloroquine.

  3. Yusuf I, Sharma S, Luqmani R, et al. Hydroxychloroquine retinopathy. Eye. 2017;31:828–845. doi:10.1038/eye.2016.298

  4. Corradetti G, Violanti S, Au A. et al. Wide field retinal imaging and the detection of drug associated retinal toxicity. Int J Retin Vitr. 2019;5:26. doi: 10.1186/s40942-019-0172-0

  5. Ahn SJ, Lee BR. Hydroxychloroquine retinopathy update. J Rheum Dis. 2018;25(3):153. doi: 10.4078/jrd.2018.25.3.153

  6. Muller R. Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilitiesRheumatol Int. 2021;41(7):1189-1202. doi:10.1007/s00296-021-04868-6

  7. Lin T, Marmor MF, Barbhaiya M, et al. Baseline retinal examinations in patients with systemic lupus erythematosus newly initiating hydroxychloroquine treatment in a US Medicaid systemic lupus erythematosus population, 2000–2010. Arthritis Care Res. 2018;70(11):1700-1706. doi: 10.1002/acr.23530

  8. Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye. 2017;31(6):828-845. doi: 10.1038/eye.2016.298

  9. American Academy of Opthalomology. What is Plaquenil?

  10. Hsu ST, Ponugoti A, Deaner JD, Vajzovic L. Update on Retinal Drug ToxicitiesCurr Ophthalmol Rep. 2021;9(4):168-177. doi:10.1007/s40135-021-00277-x

  11. Della Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA. Acute chloroquine and hydroxychloroquine toxicity: A review for emergency cliniciansAm J Emerg Med. 2020;38(10):2209-2217. doi:10.1016/j.ajem.2020.07.030

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