Early and progressive hydroxychloroquin retinal toxicity: 9-year follow-up with multimodal retinal imaging

Retinopathy secondary to the use of hydroxychloroquine sulfate can cause irreversible central visual loss and progress even after stopping the drug. The pathophysiological mechanism by which this phenomenon occurs is unclear. Periodic eye exams associated with multimodal imaging exams help in the early recognition of this pathology, being essential for the realization of an early diagnosis in order to minimize adverse visual sequelae. Patients must be aware of the risk of toxicity and its possible consequences, so the use of this medication must be well-founded. Detecting early and subtle changes in visual perception can minimize damage, but not necessarily to prevent it. Medications should be discontinued, if possible, when toxicity is recognized or strongly suspected, but this is a decision to be made together with patients and their physicians, as it is indicated by an underlying pathological condition that can also lead to irreversible sequelae for patients.