Chloroquine retinopathy: Difference between revisions
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{{Infobox medical condition | |||
| name = Chloroquine retinopathy | |||
| image = [[File:1746-1596-5-20-1-l.jpg]] | |||
| caption = Fundus photograph showing changes associated with chloroquine retinopathy | |||
| field = [[Ophthalmology]] | |||
| synonyms = Bull's-eye maculopathy | |||
| symptoms = [[Visual impairment]], [[color vision]] changes, [[night blindness]] | |||
| complications = [[Permanent vision loss]] | |||
| onset = Typically after long-term use of [[chloroquine]] or [[hydroxychloroquine]] | |||
| duration = Progressive | |||
| causes = Accumulation of chloroquine in the [[retina]] | |||
| risks = High cumulative dose, long duration of use, pre-existing [[retinal disease]] | |||
| diagnosis = [[Ophthalmic examination]], [[visual field test]], [[optical coherence tomography]] (OCT), [[fundus autofluorescence]] | |||
| differential = [[Age-related macular degeneration]], [[Stargardt disease]], [[cone dystrophy]] | |||
| prevention = Regular [[eye examination]]s, dose adjustment | |||
| treatment = Discontinuation of chloroquine or hydroxychloroquine | |||
| prognosis = Variable; early detection can prevent progression | |||
| frequency = Rare | |||
}} | |||
{{Short description|A condition caused by the use of chloroquine, affecting the retina of the eye}} | {{Short description|A condition caused by the use of chloroquine, affecting the retina of the eye}} | ||
==Chloroquine retinopathy== | ==Chloroquine retinopathy== | ||
[[File:1746-1596-5-20-1-l.jpg|thumb | [[File:1746-1596-5-20-1-l.jpg|left|thumb|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. | '''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== | ==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. | 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== | ==Clinical features== | ||
Patients with chloroquine retinopathy may initially be asymptomatic. As the condition progresses, they may experience symptoms such as: | Patients with chloroquine retinopathy may initially be asymptomatic. As the condition progresses, they may experience symptoms such as: | ||
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* Decreased color vision | * Decreased color vision | ||
* Paracentral scotomas (blind spots) | * Paracentral scotomas (blind spots) | ||
The classic "bull's-eye" maculopathy is a late finding and indicates significant retinal damage. | The classic "bull's-eye" maculopathy is a late finding and indicates significant retinal damage. | ||
==Diagnosis== | ==Diagnosis== | ||
The diagnosis of chloroquine retinopathy is primarily clinical, supported by various imaging techniques. These include: | The diagnosis of chloroquine retinopathy is primarily clinical, supported by various imaging techniques. These include: | ||
| Line 24: | Line 39: | ||
* [[Fundus autofluorescence]]: To detect early RPE damage. | * [[Fundus autofluorescence]]: To detect early RPE damage. | ||
* [[Multifocal electroretinography]] (mfERG): To assess retinal function. | * [[Multifocal electroretinography]] (mfERG): To assess retinal function. | ||
==Management== | ==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. | 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== | ==Prevention== | ||
Preventive measures include: | Preventive measures include: | ||
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* Regular follow-up examinations, typically annually, after five years of therapy or sooner if risk factors are present. | * 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. | * Dose adjustment based on ideal body weight to minimize risk. | ||
==Prognosis== | ==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. | 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. | ||
==See also== | |||
== | |||
* [[Retinal disease]] | * [[Retinal disease]] | ||
* [[Maculopathy]] | * [[Maculopathy]] | ||
* [[Antimalarial drugs]] | * [[Antimalarial drugs]] | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:Retinal disorders]] | [[Category:Retinal disorders]] | ||
[[Category:Drug-induced diseases]] | [[Category:Drug-induced diseases]] | ||
Latest revision as of 01:53, 5 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC
| Chloroquine retinopathy | |
|---|---|
| |
| Synonyms | Bull's-eye maculopathy |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Visual impairment, color vision changes, night blindness |
| Complications | Permanent vision loss |
| Onset | Typically after long-term use of chloroquine or hydroxychloroquine |
| Duration | Progressive |
| Types | N/A |
| Causes | Accumulation of chloroquine in the retina |
| Risks | High cumulative dose, long duration of use, pre-existing retinal disease |
| Diagnosis | Ophthalmic examination, visual field test, optical coherence tomography (OCT), fundus autofluorescence |
| Differential diagnosis | Age-related macular degeneration, Stargardt disease, cone dystrophy |
| Prevention | Regular eye examinations, dose adjustment |
| Treatment | Discontinuation of chloroquine or hydroxychloroquine |
| Medication | N/A |
| Prognosis | Variable; early detection can prevent progression |
| Frequency | Rare |
| Deaths | N/A |
A condition caused by the use of chloroquine, affecting the retina of the eye
Chloroquine retinopathy[edit]
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[edit]
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[edit]
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[edit]
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[edit]
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[edit]
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[edit]
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.
