Chloroquine retinopathy: Difference between revisions

Revision as of 06:05, 16 February 2025

A condition caused by the use of chloroquine, affecting the retina of the eye

Chloroquine retinopathy

Chloroquine retinopathy, also known as hydroxychloroquine retinopathy, is a retinal disorder caused by the use of the antimalarial drugs chloroquine and hydroxychloroquine. These medications are commonly used in the treatment of rheumatoid arthritis, systemic lupus erythematosus, and other autoimmune diseases. The condition is characterized by damage to the retina, particularly the macula, which can lead to vision loss if not detected early.

Pathophysiology

Chloroquine and hydroxychloroquine are known to bind to melanin in the retinal pigment epithelium (RPE), leading to toxic effects on the retina. The accumulation of these drugs in the RPE can cause damage to the photoreceptor cells and the RPE itself, resulting in the characteristic "bull's-eye" maculopathy seen in advanced cases.

Clinical features

Patients with chloroquine retinopathy may initially be asymptomatic. As the condition progresses, they may experience symptoms such as:

Blurred vision
Difficulty reading
Decreased color vision
Paracentral scotomas (blind spots)

The classic "bull's-eye" maculopathy is a late finding and indicates significant retinal damage.

Diagnosis

The diagnosis of chloroquine retinopathy is primarily clinical, supported by various imaging techniques. These include:

Fundus photography: To document changes in the retina.
Optical coherence tomography (OCT): To detect early structural changes in the retina.
Visual field testing: To identify functional deficits.
Fundus autofluorescence: To detect early RPE damage.
Multifocal electroretinography (mfERG): To assess retinal function.

Management

The primary management strategy for chloroquine retinopathy is the early detection and cessation of the offending drug. Once significant retinal damage has occurred, it is often irreversible. Regular screening is recommended for patients on long-term chloroquine or hydroxychloroquine therapy to detect early signs of retinopathy.

Prevention

Preventive measures include:

Baseline ophthalmologic examination before starting therapy.
Regular follow-up examinations, typically annually, after five years of therapy or sooner if risk factors are present.
Dose adjustment based on ideal body weight to minimize risk.

Prognosis

The prognosis of chloroquine retinopathy depends on the stage at which it is detected. Early detection and drug cessation can prevent progression and preserve vision. However, once advanced retinopathy has developed, the visual prognosis is poor.

Related pages

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-'''Chloroquine Retinopathy''' is a medical condition characterized by damage to the [[retina]] of the eye that occurs as a side effect of long-term or high-dose use of chloroquine, a medication commonly used for the treatment of [[malaria]], [[rheumatoid arthritis]], and [[lupus erythematosus]]. This condition is a form of [[toxic retinopathy]], where the toxicity of a drug leads to retinal damage, potentially resulting in permanent vision loss if not identified and managed promptly.
+{{Short description|A condition caused by the use of chloroquine, affecting the retina of the eye}}
-==Causes and Risk Factors==
+==Chloroquine retinopathy==
-Chloroquine retinopathy is primarily caused by the accumulation of chloroquine in the [[retinal pigment epithelium]] (RPE), which leads to damage of the photoreceptor cells in the retina. The risk of developing this condition increases with the total cumulative dose of chloroquine. Other risk factors include long-term use of the drug (typically over five years), higher daily doses, and the presence of pre-existing retinal disease. Kidney or liver dysfunction, which can affect the metabolism and excretion of the drug, may also increase the risk.
+[[File:1746-1596-5-20-1-l.jpg|thumb|right|Fundus photograph showing changes in the retina due to chloroquine retinopathy]]
+'''Chloroquine retinopathy''', also known as '''hydroxychloroquine retinopathy''', is a retinal disorder caused by the use of the antimalarial drugs [[chloroquine]] and [[hydroxychloroquine]]. These medications are commonly used in the treatment of [[rheumatoid arthritis]], [[systemic lupus erythematosus]], and other autoimmune diseases. The condition is characterized by damage to the [[retina]], particularly the [[macula]], which can lead to vision loss if not detected early.
-==Symptoms==
+==Pathophysiology==
-The initial symptoms of chloroquine retinopathy may be subtle and not immediately noticeable to the patient. Early signs include difficulty in reading and seeing in low light conditions. As the condition progresses, patients may experience a reduction in their central vision, development of blind spots ([[scotomas]]), and changes in color vision. Without intervention, the condition can lead to significant vision loss and even blindness.
+Chloroquine and hydroxychloroquine are known to bind to melanin in the retinal pigment epithelium (RPE), leading to toxic effects on the retina. The accumulation of these drugs in the RPE can cause damage to the photoreceptor cells and the RPE itself, resulting in the characteristic "bull's-eye" maculopathy seen in advanced cases.
+==Clinical features==
+Patients with chloroquine retinopathy may initially be asymptomatic. As the condition progresses, they may experience symptoms such as:
+* Blurred vision
+* Difficulty reading
+* Decreased color vision
+* Paracentral scotomas (blind spots)
+The classic "bull's-eye" maculopathy is a late finding and indicates significant retinal damage.
 ==Diagnosis==
-The diagnosis of chloroquine retinopathy involves a comprehensive eye examination, including a review of the patient's medical history, particularly their use of chloroquine. Diagnostic tests may include:
+The diagnosis of chloroquine retinopathy is primarily clinical, supported by various imaging techniques. These include:
-* [[Visual field test]] to detect any blind spots in the vision.
+* [[Fundus photography]]: To document changes in the retina.
-* [[Optical coherence tomography]] (OCT) to obtain detailed images of the retina, allowing for the identification of any structural changes.
+* [[Optical coherence tomography]] (OCT): To detect early structural changes in the retina.
-* [[Fundus autofluorescence]] (FAF) imaging to assess the health of the retinal pigment epithelium.
+* [[Visual field testing]]: To identify functional deficits.
-* [[Electroretinogram]] (ERG) to measure the electrical responses of the retina's light-sensitive cells.
+* [[Fundus autofluorescence]]: To detect early RPE damage.
+* [[Multifocal electroretinography]] (mfERG): To assess retinal function.
+==Management==
+The primary management strategy for chloroquine retinopathy is the early detection and cessation of the offending drug. Once significant retinal damage has occurred, it is often irreversible. Regular screening is recommended for patients on long-term chloroquine or hydroxychloroquine therapy to detect early signs of retinopathy.
-==Prevention and Management==
+==Prevention==
-Preventing chloroquine retinopathy involves careful management of chloroquine dosage and duration of therapy, taking into account the patient's body weight and overall health status. Regular eye examinations are crucial for early detection of retinal changes, ideally before the onset of symptoms. Once chloroquine retinopathy is diagnosed, the most effective management strategy is to discontinue or reduce the use of chloroquine, if medically feasible, to prevent further retinal damage. However, it is important to note that some retinal changes may be irreversible, and discontinuation of the drug does not guarantee improvement of vision.
+Preventive measures include:
+* Baseline ophthalmologic examination before starting therapy.
+* Regular follow-up examinations, typically annually, after five years of therapy or sooner if risk factors are present.
+* Dose adjustment based on ideal body weight to minimize risk.
-==Treatment==
+==Prognosis==
-There is no specific treatment for reversing the damage caused by chloroquine retinopathy. Management focuses on stopping the progression of the disease by discontinuing or adjusting the dosage of chloroquine. Patients with chloroquine retinopathy should be closely monitored by an ophthalmologist, and supportive treatments may be recommended to help manage symptoms and maintain the best possible vision.
+The prognosis of chloroquine retinopathy depends on the stage at which it is detected. Early detection and drug cessation can prevent progression and preserve vision. However, once advanced retinopathy has developed, the visual prognosis is poor.
-==Conclusion==
+==Related pages==
-Chloroquine retinopathy is a serious and potentially vision-threatening condition that underscores the importance of regular eye examinations for patients undergoing long-term chloroquine therapy. Early detection and appropriate management are key to preventing significant vision loss.
+* [[Retinal disease]]
+* [[Maculopathy]]
+* [[Antimalarial drugs]]
-[[Category:Eye diseases]]
+[[Category:Ophthalmology]]
+[[Category:Retinal disorders]]
 [[Category:Drug-induced diseases]]
-{{medicine-stub}}