Asymmetric Hydroxychloroquine (Plaquenil) Retinal Toxicity

Hydroxychloroquine maculopathy is classically described as a symmetric disease, but as this case shows, it can present with asymmetry. Panel A shows a faint perimacular pigmentary abnormality of the right eye. Panel B shows no macular pigment changes. Panel C shows a frame from the fluorescein angiogram of the right eye. A bulls eye window defect is seen (yellow arrow). Panel D shows that no maculopathy is present in the left eye. The patient was taken off hydroxychloroquine and re-examined two years later. By this time, the left eye developed maculopathy. To see this later set of pictures, click on the file "Asymmetric Hydroxychloroquine (Plaquenil) Toxicity Two Years Later".