Dry Macular Degeneration Masquerading as Hydroxychloroquine Maculopathy
One risk factor for hydroxychloroquine toxicity is preexisting macular disease. This patient has dry macular degeneration with an annular area of retinal pigment epithelial atrophy around each fovea that resembles the bulls-eye maculopathy of advanced hydroxychloroquine maculopathy (yellow arrows). The SD-OCT scans show perifoveal loss of the inner segment/ outer segment junction, as is seen in hydroxychloroquine maculopathy (turquoise arrows). It would be difficult to monitor such a patient for onset of hydroxychloroquine toxicity because such similar changes to toxicity are present as a preexisting condition.