Pattern of Retinopathy: Although the locus of toxic damage is parafoveal in many eyes, Asian patients often show an extramacular pattern of damage. Dose: We recommend a maximum daily HCQ use of 5.0 mg/kg real weight, which correlates better with risk than ideal weight. Malaria chloroquine prophylaxis Chloroquine resistant falciparum malaria Most cases of chloroquine retinopathy have developed when a higher than currently recommended 3 mg/kg/day using lean body weight dose was used. 21 A daily dose exceeding 250 mg with a total cumulative dose between 100 and 300 g is customarily needed to produce toxicity. 22 One study showed a 19% incidence of chloroquine retinopathy in. Bull’s Eye Retinopathy Early macular toxicity can cause stippling or mottling of the RPE Next, granular pigmentation and loss of the normal foveal reflex can occur It’s believed but not proven that if early macular changes are detected and the medication is stopped, any toxicity that has occurred can be reversed.1 Bull's-eye maculopathy has been associated with various macular diseases, most notably chloroquine and hydroxychloroquine maculopathy, cone dystrophy, and Stargardt disease Table 1.1-4 To our knowledge, bull's-eye maculopathy associated with chronic macular holes has not been previously reported. Risk of Toxicity: The risk of toxicity is dependent on daily dose and duration of use. There are no similar demographic data for CQ, but dose comparisons in older literature suggest using 2.3 mg/kg real weight. Chloroquine retinopathy bulls eye Recommendations on Screening for Chloroquine and., Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy Advil with plaquenilPlaquenil for lupus nephritis Bull’s Eye Retinopathy Early macular toxicity can cause stippling or mottling of the RPE Next, granular pigmentation and loss of the normal foveal reflex can occur It’s believed but not proven that if early macular changes are detected and the medication is stopped, any toxicity that has occurred can be reversed.1 If the maculopathy continues to progress, concentric zones of. Early Plaquenil Toxicity Detected without Bull’s Eye.. Bull's-eye Maculopathy Associated With Chronic Macular Hole.. Hydroxychloroquine and Chloroquine Retinopathy.. Chloroquine retinopathy presents as a characteristic “bulls-eye” appearance of the macula, producing a ring scotoma in the field of vision. Figure 1 is an image of an ocular fundus using autofluorescence to designate an area of retinal damage. Chloroquine and Hydroxychloroquine. Chloroquine and its derivative, hydroxychloroquine sulfate, which have been useful in treating malaria and in larger doses, collagen-vascular disease, cause a cumulative dose-related pigmentary retinopathy. Apr 20, 2011 3. Levy GD, Munz SJ, Paschal J, et al. Incidence of hydrochloroquinine retinopathy in a large multicentered outpatient practice. Arthritis Rheum. 1997 Aug;4081482-6. 4. Marmor MF, Carr RE, Easterbrook M, et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy a report by the American Academy of Ophthalmology.