Ocular safety of hydroxychloroquine.

Analysis of all published cases and Food and Drug Administration reports of retinopathy induced by hydroxychloroquine did not show any evidence of permanent visual-field scotomas occurring when the daily dose did not exceed 6.5 mg/kg body weight for maintenance therapy. Small risk factors may appear at this dosage level only when the duration of treatment exceeds ten years and/or chronic renal insufficiency is present. Because macular diseases not related to this drug commonly occur in older patients, periodic ophthalmologic examinations and central-field testing are recommended. A modified Amsler grid macular screening test is described, and participation of the treating physician in the testing program is encouraged to provide the maximum medicolegal protection.