Patient treated with antimalarial drug under the supervision of a rheumatologist and ophthalmologist Review article
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Abstract
Patients who come to see an ophthalmologist often have systemic diseases, the treatment of which can affect the condition of the eye. Such medications include the so-called antimalarial drugs chloroquine and hydroxychloroquine, which are used in the treatment of systemic lupus erythematosus or rheumatoid arthritis. During their use, regular ophthalmological follow-up is necessary.
In the early stages of antimalarial use, patients are usually asymptomatic, while advanced maculopathy or peripheral retinopathy can cause irreversible vision loss. The main risk factors for maculopathy are high doses (more than 5 mg/kg/24 h for hydroxychloroquine) and a long duration of use (greater than 5 years). Renal or liver impairment or concomitant use of tamoxifen increase the risk of ocular damage. Risk factors also include age and concurrent retinal disease.
Ophthalmic screening should include evaluation of visual acuity, colour vision, Amsler test, fundus and additional tests such as optical coherence tomography, electroretinogram, fundus autofluorescence, and visual field. The decision to discontinue the drug should be made jointly with the rheumatologist or attending physician, after taking into account the systemic effects of the drug.
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