She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Pharmacological classification of hydroxychloroquine Plaquenil and irritable bowel syndrome Chloroquine phostate for ich Symptoms and SignsMechanism of ToxicityMedication DosageRisk For ToxicityMonitoring GuidelinesConclusion Hydroxychloroquine And Chloroquine Screening 2016 AAO Recommendations The American Academy of Ophthalmology released an updated set of screening recommendations for hydroxychloroquine Plaquenil and chloroquine to account for the many studies that have shown the effects of these medications on the retina 1. Newer guidelines state that daily dose 5mg/kg of real weight/day can lead to toxicity. Retinal toxicity is irreversible and can progress after cessation of hydroxychloroquine, thus early screening is important to limit potential vision loss. Baseline screening and annual screening after five years is recommended. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Plaquenil retinal testing guidelines New Guidelines for Hydroxychloroquine Visual Screening, Hydroxychloroquine And Chloroquine Screening 2016 AAO. Hydroxychloroquine 400 mgResidul plaquenil in the eye New Screening Guidelines for Hydroxychloroquine Toxicity Experts explain their role in clinical practice. March 1, 2011. and potentially progressive, retinal toxicity for which no effective treatment exists. Objective changes typically precede complaints of visual loss. and that ancillary testing is important in screening for early disease. Retinal Physician - New Screening Guidelines for.. Hydroxychloroquine Plaquenil Toxicity and.. Hydroxychloroquine and Retinal Screening. The Retina Group of New York provides all of these testing modalities and is the only center on Long Island with mf ERG. Treatment. The treatment for early toxicity usually requires stopping Plaquenil. Patients taking Plaquenil should have an early baseline assessment of visual acuity, macular appearance and central field sensitivity. Bull’s Eye Retinopathy Early macular toxicity can cause stippling or mottling of the RPE Next, granular pigmentation and loss of the normal foveal reflex can occur It’s believed but not proven that if early macular changes are detected and the medication is stopped, any toxicity that has occurred can be reversed.1 If the maculopathy continues to progress, concentric zones of. In 2002, the American Academy of Ophthalmology AAO established ocular examination guidelines for screening patients on Plaquenil therapy. Testing included a comprehensive eye exam that consisted of an assessment of the posterior segment with careful evaluation of associated macular changes or signs of retinal disease. 4 Baseline fundus photography was considered as an optional test.