What is Plaquenil (hydroxychloroquine)?
Plaquenil (hydroxychloroquine) is an oral medication commonly used to treat autoimmune and inflammatory conditions such as lupus, rheumatoid arthritis, and Sjögren’s syndrome. It is generally safe and effective but with long-term use or higher doses, it can affect the retina.
How can Plaquenil affect your eyes?
The retina is the light-sensitive tissue at the back of your eye that allows you to see clearly. Plaquenil can cause retinal toxicity (maculopathy), which affects your central and paracentral vision in white patients and mid-peripheral retina/vision in black and asian patients.
Early on, you may not notice symptoms. Over time, vision may become:
- Blurry or distorted
- Less sharp
- Difficult in low light or at night
Once damage occurs, it is irreversible, and in some cases, it may continue to progress even after stopping the medication. This is why we need to check you and rarely, stop the medication before it causes toxicity to your retina and vision.
Why is early detection so important?
In the past, eye doctors looked for a late-stage sign called “bull’s eye maculopathy.” Today, with advanced technology, we aim to detect changes much earlier—before vision is affected. You can see photos of this on our blog/website.
Early detection allows us to:
- Monitor safely while you continue treatment
- Communicate with your prescribing physician
- Prevent permanent vision loss
What increases your risk of retinal toxicity?
The most important factors are dose and duration.
Other risk factors include:
- Taking the medication for more than 5 years
- Higher daily doses than recommended (greater than 5 mg/kg/day)
- Age over 60
- Kidney or liver disease
- Use of tamoxifen (breast cancer medication)
- Pre-existing retinal or macular disease
- Significant weight changes
When taken at the recommended dose, risk remains low in the first 5–10 years but regular monitoring is still essential.
What tests are needed to monitor your eyes?
The American Academy of Ophthalmology recommends:
- Baseline exam before or soon after starting medication
- Annual screening after 5 years (or earlier if high risk)
Key tests include:
- Dilated eye exam
- Visual field testing (10-2 for macula)
- OCT (Optical Coherence Tomography) to scan the retina
- Fundus auto-fluorescence (FAF) photos
What does retinal toxicity look like?
Plaquenil toxicity damages the cells in the macula responsible for sharp, detailed vision. In advanced stages, it can lead to:
- Loss of central vision
- Difficulty reading or recognizing faces
- Reduced color vision
- Night vision problems
Can supplements prevent this condition?
While nutrients like lutein and zeaxanthin are helpful in other retinal conditions like macular degeneration, there is no proven supplement that prevents Plaquenil toxicity.
The most effective protection is early detection through regular eye exams.
How can you protect your vision?
- Get a baseline and regular eye exams
- Take your medication exactly as prescribed
- Inform your eye doctor of all medications you take
- Report any changes in your vision immediately
When should you call your eye doctor?
If you notice:
- Blurred or distorted central vision
- Trouble reading or seeing fine details
- Changes in color vision
- Difficulty seeing at night
Do not wait—early evaluation can make a critical difference.
We’re here to help you protect your sight.
If you are currently taking Plaquenil or may start it soon, proactive eye care is essential.
Call our office today at (804) 270-3333. Schedule your comprehensive eye exam with Dr. Pradhan to establish your baseline and ensure your eyes are being safely monitored.
Your vision is precious—and with the right care, it can be protected for years to come.