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. Chloroquine endosomal escape Hydroxychloroquine trial net Plaquenil pill dosage Recently, specialists have announced new guidelines for Plaquenil screenings because of associated retinal problems while taking Plaquenil. Also, the technology for detecting retinal changes has improved since the initial guidelines were set. The new guidelines recommend eye doctors perform a comprehensive eye exam, including the following Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity a review Review of mfERG ring ratios in Plaquenil toxicity. Lyons JS1, Severns ML. Author information 1Georgetown University/Washington National Eye Center, Washington, DC, USA. [email protected] Marie Stamper, CMM Ward Eye Center, FL Answer Plaquenil hydroxychloroquine is a drug used to treat malaria, lupus erythematous, ormost commonlyrheumatoid arthritis. A potential side effect of the drug is ocular change that can affect the patients vision; the patient should be monitored regularly to check for these 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. How to bill for following plaquenil retina How to pick the right benefit notice and bill for medications, Using multifocal ERG ring ratios to detect and follow. Chloroquine hyperpigmentation pictures face SIDE EFFECTS. The following adverse reactions have been identified during post-approval use of PLAQUENIL or other 4-aminoqunoline compounds. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Side Effects of Plaquenil Hydroxychloroquine, Warnings, Uses. Ophthalmology Reader Question Coding for Plaquenil Toxicity.. New Plaquenil Guidelines. A documented disorder of the optic nerve, the neurologic visual pathway, or retina. Patients with a previously diagnosed retinal detachment do not need a pretreatment visual field examination. Additionally, patients with an established diagnosed cataract do not need a follow-up visual field unless other presenting symptomatology is documented. Diagnosis Hydroxychloroquine-induced retinal toxicity Discussion. Chloroquine CQ and hydroxychloroquine Plaquenil HCQ have been used for many years, initially for the treatment of malaria but now more commonly for the treatment of inflammatory diseases such as rheumatoid arthritis and lupus 1is now considered for new disease applications in diabetes, heart disease and adjunct. Retinal thickness analysis is a non-invasive and non-contact imaging technique that takes direct cross-sectional images of the retina. These high resolution images capture ocular structures and provide data to create thickness maps of the retina. Retinal thickness is directly correlated to ocular disease, including retinal disorders and glaucoma.