Hydroxychloroquine Keratopathy - Example #2

This 52 year old woman with rheumatoid arthritis was placed on hydroxychloroquine 400 mg/d 6 months before being seen for a subconjunctival hemorrhage. During the course of the examination, in addition to the left subconjunctival hemorrhage, she was noted to have bilateral verticellate keratopathy (white arrows). She was not taking amiodarone or other drugs that are known to cause corneal deposits besides hydroxychloroquine. She was 5 feet 1 inch tall and weighed 211 pounds. Her ideal body weight was 127 pounds. Thus her adjusted daily dose was 6.93 mg/kg/d - a toxic dose. She was advised that she had hydroxychloroquine deposits in her corneas that might go away with revision of her dosage to a nontoxic level. Her internist was notified. In addition, a baseline screening examination for retinopathy was recommended as it had not been done yet.