Damage to the eye through hydroxychloroquine toxicity is not treatable or reversible, so it is important to report any changes in your vision early. You should have a baseline eye exam within one year of starting ocular toxicity treatment with your eye care provider.
[6] HCQ retinopathy is not reversible and cellular damage may progress for a number of years even after the drug is stopped. Therefore, it is essential to continue following the patient appropriately.
Eye Effects from Plaquenil
The retinal toxicity includes a change in a ring-shaped pattern around the center of vision. This pattern is only seen with toxicity from medications such as Plaquenil. In addition to a ring-shaped defect in vision, the retinal toxicity may lead to glare around lights or halos.
Effects on the eye
The most important side effect of hydroxychloroquine is on the eye. Blurred vision may occur in the first few weeks after starting hydroxychloroquine. This usually returns to normal even when you continue taking the tablets.
Plaquenil binds to retinal pigment cells, causing adverse changes in vision that occur slowly over time. Objects may start to appear blurry or distorted. In the most serious cases of Plaquenil-induced retinal toxicity, the macula is completely destroyed.
“Eye damage due to Plaquenil is not common,” he says. “Rarely will anybody who has good vision and minimal symptoms develop loss of central vision or ability to read if annual screening is done and visual are symptoms reported as soon as they occur so the medication can be stopped if toxicity occurs.
Retinal toxicity from hydroxychloroquine is rare, but even if the medication is discontinued, vision loss may be irreversible and may continue to progress. It is imperative that patients and physicians are aware of and watch for this drug's ocular side effects.
People may need to stop taking hydroxychloroquine because of side effects. They should not stop taking the drug on their own without the help of their medical provider. Plaquenil stays in the body for around three months and it may take a while for side effects to go away.
Plaquenil stays in your body for about 3 months. If you must stop it, it will take a while for the side effects to go away. You should have an eye examination every year to prevent a very rare but serious eye problem. Less than one person in 5,000 develops the problem.
Patients starting treatment with Plaquenil should have a baseline eye examination within the first year of taking this medication and then regular screenings thereafter; every six months or yearly as advised by your eye doctor.
A Plaquenil screening may include a visual field test, OCT imaging, multifocal ERG, and photos of your eye. If there are any signs of damage to your retina, your ophthalmologist may ask you to consult with your primary care physician to see if you should continue taking the drug.
As mentioned above, the condition of your oral health affects much more than just your teeth and gums. In fact, The American Academy of Ophthalmology shared that periodontal disease and other oral infections can lead to an inflammatory response that results in damage to the optic nerve.
Using Plaquenil for a long period of time may harm the retina, causing serious vision loss. People with retinal damage from Plaquenil are not aware at first that they are losing vision. Unfortunately, once they lose a severe amount of vision loss, it is permanent.
There's usually little you or your optometrist can do to reverse the damage already done to the eye. It's always better to prevent damage than try to cure it, and maintaining a healthy diet is a meaningful way to protect your vision health.
The study found that a person who decreases her/his HCQ dose is 54% more likely to experience a flare sooner than someone who maintains the same dose. And, if someone stops taking the medication entirely, she/he is 61% more likely to have a flare sooner than someone who continues on HCQ.
Visual field defects are considered irreversible because the retina and optic nerve do not regenerate. Nevertheless, there is some potential for recovery of the visual fields.
You may want to limit your consumption of grapefruit or grapefruit juice during treatment with hydroxychloroquine. Grapefruit juice can significantly increase the blood levels and effects of hydroxychloroquine, which may result in an irregular heart rate or other conduction disturbances.
Its main side effects are gastrointestinal upset (vomiting, diarrhea, stomach cramps), skin rash, headache, dizziness, and ocular toxicity. However, serious side effects including arrhythmia, bronchospasm, angioedema, and seizures can rarely occur.
Hydroxychloroquine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
To lower the daily dosage, to adjust for low weight, or if there is kidney damage or kidney failure, HCQ may be taken every other day or tablets may be broken in half. To reduce stomach upset, HCQ is best taken with food or milk.
Adults—At first, 400 to 600 milligrams (mg) taken as a single dose or in two divided doses per day. Then, 200 mg once a day or 400 mg taken as a single dose or in two divided doses per day. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor.
You can take hydroxychloroquine for a long time if it's working for you, but your doctor will monitor you while you're taking it. For example you may have regular full blood counts (tests to check the types and numbers of cells in your blood) and eye examinations.
Retinal toxicity is most frequently characterized by symptoms of central visual loss including reading difficulties, reduced color vision, and central scotomata. Maculopathy ranging from a subtle disturbance of the retinal pigment epithelium to bull's-eye maculopathy has been described.
Currently, one of the primary functional screening tests recommended for the evaluation of Plaquenil retinal toxicity is 10-2 white stimulus automated visual fields; however, research shows Asian patients benefited from 24-2 or 30-2 visual fields, given that toxicity often manifests changes beyond the macula in these ...
Hydroxychloroquine may potentially result in adverse effects on the central nervous system, mainly irritability, nervousness, emotional changes, nightmares, and even true psychoses [3, 4].