Plaquenil Side Effects on Your Eyes and Vision

If you're taking Plaquenil to treat an inflammatory condition or malaria, you should be aware of the side effects that may occur to your eyes and vision.

Plaquenil (hydroxychloroquine) 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 originally used as an anti-malaria drug.

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

Man receiving an eye exam
Eric Audras / Getty Images

Hydroxychloroquin 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.)

Hydroxychloroquine retinopathy is extremely rare and is most often seen in cases where the dosage is high or the patient has been taking it for several years. When it does occur, it can be devastating to your vision.

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

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

Testing

Most rheumatologists recommend patients 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, including a full evaluation every 18-24 months during the first five years and annually thereafter.

Risk factors include advanced age and having pre-existing retinal disease.

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

  • Dilated retinal examination
  • Retinal photography (for baseline documentation only)
  • Central computerized visual field test
  • SD-OCT (spectral domain optical coherence tomography)

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

If you have odd visual changes at any time while taking Plaquenil, see a healthcare provider.

A Word From Verywell

It pays to be extra vigilant about your vision while taking Plaquenil, but remember that this is a fairly rare complication. Your regular healthcare provider, eye doctor, and pharmacist should be able to answer any questions you may have about your risk or what to look for.

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