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. Plaquenil rash Hydroxychloroquine off label uses Hydroxychloroquine and ra To date, several investigators have used SD-OCT in eyes with HCQ toxicity and qualitatively evaluated thinning of the outer retinal layers or attenuation of the ellipsoid zone EZ, while others have quantitatively analysed outer retinal thickness on SD-OCT topographic map.7–10 This study aims to characterise HCQ toxicity using a newly. 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. The junction remains in the fovea white arrow. When this thinning is translated into an OCT map, a bulls-eye pattern of thinning is manifested, as shown in the image entitled "Time Domain OCT Map in Hydroxychloroquine Toxicity". The patient shown here is the same one shown in the image "Asymmetric Hydroxychloroquine Plaquenil Retinal Toxicity". 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. Oct bull ey macula ellipsoid plaquenil My Take on New Ocular Screening Guidelines for Plaquenil., Early Plaquenil Toxicity Detected without Bull’s Eye. Interactions with plaquenil and leflunomidePlaquenil and syncopePompe glycogen storage and hydroxychloroquineHydroxychloroquine what herbs to takeCan plaquenil and metoprolol tartrate be taken together There is a bull’s eye pigment irregularity in the macula. OS Vertical C/D ratio is 0.1. There is posterior vitreous separation. There is a mild bull’s eye pigment irregularity in the macula. SPECTRALIS-SD-OCT SCAN The OCT scan shows typical Plaquenil toxicity without retinal atrophy and a circle around the macula. Plaquenil Toxicity - Mild - Partial Bull's Eye Maculopathy.. Time Domain OCT in Hydroxychloroquine Plaquenil Toxicity.. Spectral domain optical coherence tomography as an effective.. The presence of bull’s-eye maculopathy indicates the disease has been progressing for years, resulting in foveal thinning and likely vision loss. 8 SD-OCT is a highly sensitive and reproducible imaging modality used in the detection of Plaquenil retinal toxicity. The preferential loss of photoreceptor IS/OS junction makes SD-OCT an ideal tool. Definition Bull’s eye maculopathy describes a number of different conditions in which there is a ring of pale-looking damage around a darker area of the macula. The macula can often appear to have circular bands of different shades of pink and orange. Age of onset and severity of sight loss varies, and it can be Nov 01, 2015 Hydroxychloroquine Maculopathy An Update on Screening and Diagnosis A brief guide for imaging SHIRI SHULMAN, MD. H ydroxychloroquine HCQ; Plaquenil, Sanofi, Bridgewater, NJ is an antimalarial agent that is also commonly used as a treatment for a variety of rheumatologic and dermatologic conditions, such as rheumatoid arthritis and systemic lupus erythematosus.