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Most viewed - Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy 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.
Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Fundus Autofluorescence1233 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 OS	Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy OCT Line Scan1018 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 OS	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs937 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs880 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.
Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs878 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.	Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Video - TAKES TIME TO LOAD852 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 OS	Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Line Scan829 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 OS	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs821 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.
Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Fundus Autofluorescence789 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 OS	782 views	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs749 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs695 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.
Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Video - TAKES TIME TO LOAD681 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 OS	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs680 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs672 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.	Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Posterior Pole MAP665 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 OS
Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Infra-red Image647 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 OS	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs640 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs629 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs610 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.
Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs603 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.	Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy OCT Posterior Pole MAP598 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 OS	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs587 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs583 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.
Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs560 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs536 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.	Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - InfraRed Image536 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 OS	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs524 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.
Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs508 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs506 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs501 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs495 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.
Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs485 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs484 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs476 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.	Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbs466 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.
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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.