Hydroxychloroquine-induced bull's eye maculopathy

Abstract

A woman aged 28 years with systemic lupus erythematous and abnormal kidney function, treated with 4·5 mg/kg hydroxychloroquine daily for 15 years (cumulative dose 1369 g), presented with bilateral progressive central vision loss for 2 months. The patient had no known previous exposure to chloroquine. Best corrected visual acuity was 20/40 in her right eye and 20/30 in her left eye. Funduscopy showed a concentric hypopigmentation around both foveas (figure). Spectral domain optical coherence tomography of the macula revealed photoreceptor layer and retinal pigmented epithelium loss, and automated 24-2 visual fields showed bilateral central scotomas (figure). These findings were consistent with bull's eye maculopathy, a classic feature of advanced hydroxychloroquine toxicity. 3 months after medication was stopped, the patient's visual acuity had remained stable, and no other complaints were reported.