Hydroxychloroquine Retinopathy with Minimal Fundus Abnormalities

This 68 year old woman with systemic lupus erythematosus had been on hydroxychloroquine at a dosage of 400 mg/d (6.52 mg/kg/d) for eight years. Her optometrist had checked her yearly during that time until in the eighth year he became suspicious of hydroxychloroquine toxicity because of visual field changes. A - The fundus photographs show a broad arc of retinal pigment epithelial mottling temporal to the macula OU (white arrows). This subtle change was missed by the optometrist and by the first ophthalmologist to whom he sent her. The paracentral pigment epithelial abnormalities are more variable than textbook descriptions of the condition would suggest.