Vázquez-Dorrego XM, Ruiz-Bilbao SM, Poposka D, Aranda-Yus A, Hayik B, Broc Iturralde, L.


Fundus appearance would be documented before starting long-term antipaludic therapy in rheumatologic or dermatologic diseases.


A 34 years old female patient was sent for screening of possible retinal toxicity six months after beginning hydroxichloroquine therapy for systemic lupus erythematosus. To our knowledge, no ophthalmic assessment had been made before starting the drug intake. In this moment, the patient did not have any kind of complaint. Visual acuity was 20/20 OU. Amsler test showed puntiform absolute scotomata in the central area. Ishihara testing showed a slight red-green defect. Ten-degree central Octopus visual field revealed a bilateral deep round central scotoma respecting the foveal area. Fundus examination revealed perifoveal depigmentation with the appearance of a bull’s eye disease. Fluorescein angiography showed bilateral pigment epithelium window defects. Electroretinogram and electrooculogram were found to be normal.

Effectiveness / Safety:

Although hydroxychloroquine-induced retinal toxicity has been described, the minimum intake required for retinal toxicity at normal dosage is generally stated between six and seven years. Toxicity has been described before this time, although always in patients having a high dosage, or when dosage had not been adjusted to the ideal weight of the patient. To our knowledge, no case of toxicity has been described before one year of therapy. The whole exploration led us, finally, to make the diagnosis of benign concentric annular macular dystrophy, which probably was already present before starting of antipaludic therapy.