The Eye-Opening Truth About Hydroxychloroquine: What You Need to Know

September 7, 2023

In the realm of healthcare, particularly in the treatment of autoimmune diseases like rheumatoid arthritis and lupus, Hydroxychloroquine is a medication that often comes to the forefront. Known by its brand names Plaquenil, Quineprox, and others, this drug is widely prescribed for its efficacy. However, it is imperative for patients to be aware of its potential ocular side effects. This article aims to provide an in-depth understanding of Hydroxychloroquine’s impact on eye health.

What is Hydroxychloroquine?

Hydroxychloroquine is a medication commonly used to treat autoimmune diseases like rheumatoid arthritis and lupus. It helps to reduce inflammation and can be quite effective in managing symptoms. However, like all medications, it comes with its set of side effects.

How Can Hydroxychloroquine Affect Your Eyes?

Hydroxychloroquine has the potential to cause a specific type of eye issue known as retinal toxicity. The retina is a layer of tissue at the back of the eye that plays a crucial role in vision. It captures light and converts it into neural signals that are sent to the brain. When retinal toxicity occurs, it can interfere with this process, leading to a range of vision problems.

Types of Retinal Toxicity:

Early Stage: In the early stages, retinal toxicity may be asymptomatic or may manifest as difficulty in adjusting to dark environments, a condition known as night blindness.
Intermediate Stage: As the condition progresses, patients may experience blurriness in their central vision, making tasks like reading or recognizing faces difficult.
Advanced Stage: In severe cases, retinal toxicity can lead to a complete loss of vision. This is often irreversible and can significantly impact the quality of life.

Risk Factors:

Duration of Use: The longer you’ve been on the medication, the higher the risk.
High Dosage: Higher doses can accelerate the onset of toxicity.
Pre-existing Eye Conditions: Those with existing eye issues may be at a higher risk.

Mechanism:

The drug tends to accumulate in the pigment of the retina, disrupting its function and causing damage over time. This is why the side effects may not be immediate but can develop gradually.

What Can You Do?

Regular Eye Check-ups

If you are taking Hydroxychloroquine, regular eye examinations are not just a recommendation; they are a necessity. These check-ups are crucial for early detection of any retinal abnormalities that could be indicative of Hydroxychloroquine-induced toxicity.

Components of the Eye Exam:

Visual Acuity Test: This is the standard eye chart test, which measures how well you see at various distances.
Visual Field Test: This test measures your side (peripheral) vision and can detect if the drug is affecting the edges of your visual field.
Optical Coherence Tomography (OCT): This is an imaging test that looks at the cross-sectional layers of the retina. It can detect early signs of retinal damage.
Fundus Photography: This involves capturing photographs of the back of the eye, including the retina, to monitor any changes over time.
Fluorescein Angiography: In some cases, a dye may be injected into your arm to observe the blood flow in the retina and choroid, another layer of the eye.

Frequency:

Initial Examination: An initial baseline eye exam is recommended before or shortly after beginning the medication.
Annual Exams: After the initial exam, yearly follow-ups are generally advised. However, the frequency may be increased based on your risk factors or if any issues are detected.

By adhering to a regular schedule of comprehensive eye examinations, you can significantly reduce the risk of severe ocular side effects and ensure timely intervention if any issues arise.

Targeted Lifestyle Adaptations While Taking Hydroxychloroquine

When you’re on Hydroxychloroquine, certain lifestyle changes can help you minimize the risk of retinal toxicity and other eye-related side effects. Here are some specific recommendations:

Nutrition:

Antioxidant-Rich Foods: Foods high in antioxidants like Vitamin C and E can be beneficial for retinal health. Consider adding more citrus fruits, berries, and leafy green vegetables to your diet.
Zinc: This mineral is essential for maintaining the health of the retina. Foods rich in zinc include nuts, legumes, and lean meats.

Physical Exercise:

Regular Exercise: Cardiovascular exercise such as walking or cycling can improve blood circulation, which is beneficial for retinal health. However, consult your healthcare provider before starting any new exercise regimen.

Screen Time:

Adjust Screen Brightness and Contrast: Given that Hydroxychloroquine can affect your central vision, it may be helpful to adjust the brightness and contrast on your digital devices to reduce eye strain.
Text Size: Increasing the text size on your devices can also alleviate strain on your central vision.

Eye Protection:

UV Protection: Hydroxychloroquine can make your eyes more sensitive to light. Always wear sunglasses with full UV protection when outdoors.
Blue Light Filters: Consider using blue light filters on your screens, as Hydroxychloroquine can make your eyes more susceptible to light-induced damage.

Regular Monitoring:

Self-Check: Be mindful of any changes in your vision, such as difficulties in adjusting to dark environments, as this could be an early sign of Hydroxychloroquine-induced retinal toxicity.

By adopting these targeted lifestyle changes, you can better manage the potential ocular side effects of Hydroxychloroquine. These adaptations are not a substitute for medical advice but can serve as supplementary measures to maintain your eye health.

Final Thoughts

Hydroxychloroquine is a valuable medication for many people, but it’s essential to be aware of its potential side effects. Regular monitoring and open communication with your healthcare providers can go a long way in ensuring your well-being.

If you are currently taking Hydroxychloroquine or have concerns about your eye health, we strongly recommend scheduling an appointment with Compton Eye Associates. Our team of experts is here to guide you through comprehensive eye care. To schedule your appointment, please call us at 800-936-0036.

References

Costedoat-Chalumeau, N., Dunogué, B., Leroux, G., Morel, N., Jallouli, M., Le Guern, V., … & Melles, R. B. (2015). A critical review of the effects of hydroxychloroquine and chloroquine on the eye. Clinical Reviews in Allergy & Immunology, 49(3), 317-326.

Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. (2016). Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). Ophthalmology, 123(6), 1386-1394.