Asymmetric Hydroxychloroquine Retinopathy

These are fundus photographs of the two eyes of a 67 year old woman who took 200 mg/d of hydroxychloroquine (Plaquenil) for 15 years for discoid lupud erythematosus. She was 5 feet 11 inches tall and weighed 187 pounds. Most cases of hydroxychloroquine retinopathy are symmetric, but this case shows asymmetry. There is a partial bulls-eye lesion of the right macula (white arrow) but none of the left eye which has minimal retinal pigment epithelial mottling. Despite the absence of fundus changes there was clearly a bulls-eye scotoma on 10-2 visual field testing (see the image entitled Asymmetric 10-2 Visual Field Changes in Hydroxychlroqouine Retinopathy).