“If you feel like your central vision is getting blurred, if you lose the ability to see a digital clock, if you lose color vision—if reds look kind of washed out—or if you have trouble seeing at night: Those are early signs that you might be developing Plaquenil retinopathy,” says Katz.
In the initial stages of hydroxycloroquine toxicity, patients are often asymptomatic. If they do have symptoms they complain of visual color deficits, specifically red objects, missing central vision, difficulty reading, reduced or blurred vision, glare, flashing lights, and metamorphopsia.
Plaquenil is an extremely safe medication but retinal and corneal side effects are possible. Unfortunately, the retinal side effects are largely irreversible and can lead to vision loss. So, it is critical to detect early retinal toxicity in the hopes of limiting the extent of visual loss.
Hydroxychloroquine is generally safe at normal doses, but higher amounts can damage the retina, the light-sensitive tissue at the back of the eye, and could result in partial or complete blindness.
Ocular symptoms of retinopathy associated with these medications can include blurred vision, partial loss of central and peripheral vision and in the later stage, loss of night vision. Symptoms of corneal deposits include haloes and glare.
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.
Plaquenil-induced toxicity usually will not occur before five years of taking the drug. “Eye damage due to Plaquenil is not common,” he says.
If you're taking Plaquenil for the treatment of rheumatoid arthritis or lupus symptoms, you should see an improvement within six months. If your symptoms don't improve, your doctor will likely recommend discontinuing the medication.
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.
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.
Optical Coherence Tomography (OCT) for Plaquenil
The scans completed are assessed by our optometrist to determine if there is any loss of nerve fibers or changes in the macula, which is the center of the nerves responsible for clarity in your central vision.
Serious side effects
muscle weakness, cramps, stiffness or spasms, or changes in how your skin feels such as tingling. frequent infections with a high temperature, sore throat or mouth ulcers. bruising that happens more easily than usual.
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.
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.
Symptoms of heart-related problems Plaquenil may cause include: fatigue (low energy) irregular or fast heartbeat.
Hydroxychloroquine may potentially result in adverse effects on the central nervous system, mainly irritability, nervousness, emotional changes, nightmares, and even true psychoses [3, 4].
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.
Patients usually complain of difficulty in reading, decreased vision, missing central vision, glare, blurred vision, light flashes, and metamorphopsia. They can also be asymptomatic. Most patients have a bull's eye fundoscopic appearance.
Following cumulative doses of 1000 g, the prevalence of retinal toxicity increases to 1% and is associated with an irreversible loss of vision despite cessation of the drug [82]. In some cases, progression of vision loss is present for up to one year after discontinuation of the offending agent.
As with all medicines, some people may experience side effects from taking hydroxychloroquine. 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.