A 40-year-old woman with SLE has been on hydroxychloroquine 200 mg daily for 8 years. She reports mild difficulty reading. Fundoscopy is normal, but visual field testing shows bilateral paracentral scotomas on 10-2 testing. What is the recommended management?

• A Discontinue hydroxychloroquine immediately ✓
• B Continue current dose and repeat testing in 12 months
• C Increase dose to 400 mg daily and monitor
• D Add high-dose corticosteroids

Explanation

Hydroxychloroquine causes irreversible retinal toxicity that correlates with duration of use (risk rises significantly after 5 years). Once paracentral scotomas are detected by sensitive testing (10-2 Humphrey visual field or multifocal ERG), the drug must be stopped immediately because the toxicity is progressive and irreversible. Continuing the drug will worsen vision loss. Corticosteroids are not effective for hydroxychloroquine retinopathy.

Reference: American Academy of Ophthalmology Preferred Practice Pattern, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.