She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Whorl keratopathy plaquenil Chloroquine phosphate toxic to bacteria Plaquenil hydroxychloroquine belongs to a group of medicines called quinolines. Plaquenil is used to treat or prevent malaria, a disease caused by parasites that enter the body through the bite of a mosquito. Malaria is common in areas such as Africa, South America, and Southern Asia. The guidelines recommend starting annual screening after 5 years unless additional risk factors are present that include small stature, obesity, liver or kidney disease, and retinal disease. In these cases, test on an annual basis from the start. The AAO guidelines recommend that patients get a baseline examination within the first year of use and annual screening after 5 years of use, or earlier in higher-risk patients, that is, those on higher than recommended doses of HCQ, those taking HCQ 5 years, those with persistent renal or hepatic dysfunction, those who are obese, the elderly and those with pre-existing retinal and macular disease that may make it harder to screen for early changes. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Plaquenil retinal testing guidelines New Plaquenil Guidelines -, Chloroquine And Hydroxychloroquine Toxicity - StatPearls. Has there been a plaquenil class action lawsuit Newer guidelines state that daily dose 5mg/kg of real weight/day can lead to toxicity. Retinal toxicity is irreversible and can progress after cessation of hydroxychloroquine, thus early screening is important to limit potential vision loss. Baseline screening and annual screening after five years is recommended. Hydroxychloroquine Plaquenil Toxicity and.. Hydroxychloroquine-related retinal toxicity Rheumatology.. Retinal Screening for Hydroxychloroquine Plaquenil.. Rheumatologists use hydroxychloroquine sulfate Plaquenil, Concordia Pharmaceuticals to treat autoimmune diseases, namely discoid or systemic lupus erythematosus, rheumatoid arthritis, Sjögren syndrome, and malaria. When taken at high doses and for long durations, hydroxychloroquine has been known to cause parafoveal retinal toxicity. Symptoms and SignsMechanism of ToxicityMedication DosageRisk For ToxicityMonitoring GuidelinesConclusion Lyons emphasizes the importance of annual screening and says that, although annual screening is recommended for everyone taking Plaquenil, it is imperative for people who have been taking the medication for more than 10 years, who have a higher incidence of retinal toxicity. Plaquenil-induced toxicity usually will not occur before five years of taking the drug.