While many of these can be grouped by anatomic location or type of toxicity, there are also individual medications with characteristic effects. In this article, we will describe several major categories of pharmacologic retinal toxicity and discuss examples of individual medications. Plaquenil and sarcoidosis Plaquenil dosage for sjogren's Retinal Artery Embolism, retinal pigment epithelial mottling, and severely decreased Central retinal artery occlusion with cilioretinal artery sparing Chronic signs of retinal artery occlusion include pale optic disc, thinned retinal tissue, attenuated vesselsorg Oct 07, 2008 Figure 6. A patient with Stargardt's disease and an identified mutation in the ABCA4 gene, presenting bilateral atrophy of the macula and retinal pigment epithelium that evidently reveals the choroidal vessels underneath. Subtle lipofuscin deposition surrounding the lesion was previously misdiagnosed as drusen. On examination, a telltale sign of hydroxychloroquine toxicity is a bilateral change in the retinal pigment epithelium of the macula that gives the commonly described appearance of a bull’s-eye. This is a late finding, however, and too late for screening to be useful. Both medications have been shown to bind melanin and to concentrate in the iris, ciliary body and retinal pigment epithelium, altering normal physiologic function. Chloroquine (Aralen) and hydroxychloroquine (Plaquenil) are traditional antimalarial agents now used in the treatment of autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Retinal pigment epithelial mottling of macula plaquenil Retinal Pigment Epithelium Cell–Based Treatments in., How to Spot Diseases that Mimic Dry AMD Hydroxychloroquine and loratadineAmerican academy of ophthalmology plaquenil guidelinesPlaquenil consumer medicine informationChloroquine vaccineHydroxychloroquine lose eye sight Oct 23, 2006 Retinal pigment epithelial RPE mottling in and around the macula of each eye was observed. A 1.5DD disc diameter area of RPE drop-out was noted slightly superior temporal from the macula O. D. Ocular coherence tomography OCT revealed what we interpreted as an old nonchoroidal non-neovascularized RPE detachment superior nasal from the right macula. Does Patient with Lupus Have Plaquenil Retinopathy?. Hydroxychloroquine-Induced Retinal Toxicity - American.. ICD-10-CM Diagnosis Code H35.54 Dystrophies primarily.. Jan 01, 2008 Note the perifoveal crystals and peripapillary mottling of the retinal pigment epithelium. Esther Kim, BA, is a medical student at the New York University School of Medicine. Howard F. Fine, MD, MHSc, is the medical director of the Gerstner Clinical Research Center and assistant professor in the Department of Ophthalmology at Columbia University Medical Center in New York. Later, central pigmentation develops with a hollow of depigmentation, mainly inferior to the fovea, creating the “bull’s eye” pattern. Advanced cases may demonstrate widespread retinal pigment epithelium atrophy, with a reduced visual field and decreased night vision. 3 Visual field. Ocular signs – Anterior segment - vortex keratopathy Fundus – bilateral multiple, yellow, crystalline, ring like deposits in the maculae. These persists even on cessation of treatment, macular edema, punctate retinal pigmentary changes Work up FFA – late focal staining in the macula consistent with CME.