Plaquenil and Your Eyes

What is Plaquenil?
How does Plaquenil affect your eyes?
What can I do to ensure my eyes are not affected?

What is Plaquenil?
Plaquenil (Hydroxychloroquine) is used to dampen inflammation in some forms of arthritis, especially rheumatoid arthritis and lupus. Plaquenil is usually used for long term disease control, rather than in the short term to control active bursts of inflammation. Plaquenil has important but uncommon side effects that may affect your eye.

How does Plaquenil affect your eyes?
The most important affect of Plaquenil on your eye is to damage the retina at the back of your eye. Fortunately, this is very uncommon and generally only occurs in patients on high doses or patients with bad kidney function. This sort of retinal damage may result in patchy loss of central vision or patchy loss of vision just close to the centre of your vision. There are a number of other much less important side effects of Plaquenil, including changes in the cornea and changes in the eyelids. To be at risk of eye problems from Plaquenil you need to be on quite a high dose. The dose that you can safely tolerate depends on your size. If you weigh less than 30kg, then you may run in to problems on just one tablet a day. If you weigh less than 60kg (around 9 stone) then you may be at risk of eye problems on two tablets daily.

What can I do to ensure my eyes are not affected?
It is important to promptly report any changes in vision, especially any changes in your central vision whilst you are on Plaquenil. It is also useful to check your central and near central vision regularly. It is recommended that you check you vision on an Amsler chart weekly (see below). You do this by looking at the black dot in the centre with one eye at a time and noticing if there are any gaps or irregularities in the straight lines around the black dot. If there are any changes then you should tell your rheumatologist or your eye doctor promptly. The vast majority of patients on Plaquenil get absolutely no eye problems and you should not be unduly worried or concerned. If you have a good response in your arthritis to the Plaquenil then the benefits of a Plaquenil almost certainly outweigh the small risks to your eyes. So long as you are careful with your eyes, then there are no reasons that you should develop any problems in the long term.

  1. Sit in an area with good lighting, wear your reading glasses and look at the the grid at a comfortable position (30-40cm).
  2. Cover one eye
  3. Look directly at the centre dot. While looking directly at the dot note whether all lines of the grid are straight or if any areas are distorted, blurred or dark.
  4. Repeat the test with the other eye

If you experience:

  • distortion or curvy lines
  • blurring
  • holes or spots in some areas of the grid
see your ophthalmologist immediately!