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73-year-old woman has been on Plaquenil she thinks probably for about the last twenty to twenty five years. She was diagnosed at that time with arthritis. Her sister has severe arthritis. She was tested and the tests showed not only that she was positive, but also she had very high sedimentation rates. She has been on treatment since then and fortunately she has not had any joint problems. You were concerned though because of a visual field issue, about possible Plaquenil toxicity. She also had a lung surgery in 2004 and not a sarcoma. She had breast surgery in 2005 for breast cancer, but currently she is free of any cancer. For her arthritis she is diagnosed as a possible crossover between lupus and rheumatoid arthritis and she has also fibromyalgia. VISUAL ACUITY: OD 20/70, OS 20/30. IOP: OD 15, OS 16. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. She has a posterior chamber intraocular lens in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is posterior vitreous separation. There is an area of atrophy that is concentric atrophy. OS: Vertical C/D ratio is 0.2. There is posterior vitreous separation with concentric geographic atrophy. OCT SCAN: The OCT scan shows retinal atrophy in both eyes. The average central foveal thickness in the right eye is 170 microns with a volume of 4.85 mm3. The left eye has 161 microns with a volume of 5.18 mm3. The line scans show loss of the photoreceptor integrity around the macula in both eyes. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a classic bull’s eye maculopathy in each eye from the Plaquenil toxicity. IMPRESSION: 1. PLAQUENIL TOXICITY – BOTH EYES WITH BULLS EYE MACULOPATHY DISCUSSION: I explained to the patient she has unfortunately Plaquenil toxicity. I told her to stop the drug and to talk to her doctors. I asked her to return for a check in six months or sooner if she should notice a problem.

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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs197 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs392 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs165 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs403 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs422 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs383 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs152 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs104 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs159 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs225 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs144 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs101 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs108 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs154 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs105 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs89 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs102 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs95 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs81 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs67 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs84 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs110 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs105 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs100 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs145 views73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Fundus Autofluorescence196 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS55555
(1 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - InfraRed Image127 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Line Scan307 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS55555
(1 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Video - TAKES TIME TO LOAD259 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy OCT Posterior Pole MAP153 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Fundus Autofluorescence468 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS55555
(1 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Infra-red Image227 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy OCT Line Scan427 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Posterior Pole MAP275 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Video - TAKES TIME TO LOAD376 views73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS00000
(0 votes)
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73-year-old woman has been on Plaquenil she thinks probably for about the last twenty to twenty five years. She was diagnosed at that time with arthritis. Her sister has severe arthritis. She was tested and the tests showed not only that she was positive, but also she had very high sedimentation rates. She has been on treatment since then and fortunately she has not had any joint problems. You were concerned though because of a visual field issue, about possible Plaquenil toxicity. She also had a lung surgery in 2004 and not a sarcoma. She had breast surgery in 2005 for breast cancer, but currently she is free of any cancer. For her arthritis she is diagnosed as a possible crossover between lupus and rheumatoid arthritis and she has also fibromyalgia. VISUAL ACUITY: OD 20/70, OS 20/30. IOP: OD 15, OS 16. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. She has a posterior chamber intraocular lens in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is posterior vitreous separation. There is an area of atrophy that is concentric atrophy. OS: Vertical C/D ratio is 0.2. There is posterior vitreous separation with concentric geographic atrophy. OCT SCAN: The OCT scan shows retinal atrophy in both eyes. The average central foveal thickness in the right eye is 170 microns with a volume of 4.85 mm3. The left eye has 161 microns with a volume of 5.18 mm3. The line scans show loss of the photoreceptor integrity around the macula in both eyes. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a classic bull’s eye maculopathy in each eye from the Plaquenil toxicity. IMPRESSION: 1. PLAQUENIL TOXICITY – BOTH EYES WITH BULLS EYE MACULOPATHY DISCUSSION: I explained to the patient she has unfortunately Plaquenil toxicity. I told her to stop the drug and to talk to her doctors. I asked her to return for a check in six months or sooner if she should notice a problem.