{"id":18335,"date":"2026-09-04T10:03:06","date_gmt":"2026-09-04T10:03:06","guid":{"rendered":"https:\/\/www.eyecliniclondon.com\/blog\/?p=18335"},"modified":"2026-09-04T10:03:06","modified_gmt":"2026-09-04T10:03:06","slug":"hydroxychloroquine-eye-damage","status":"publish","type":"post","link":"https:\/\/www.eyecliniclondon.com\/blog\/hydroxychloroquine-eye-damage\/","title":{"rendered":"Can Hydroxychloroquine Damage Your Eyes?"},"content":{"rendered":"

Yes, hydroxychloroquine can damage your retina, particularly when you take it for many years or at higher doses. Early retinal damage may not cause symptoms you notice, so you may need regular eye monitoring to detect changes before significant sight loss occurs.<\/p>\n

Hydroxychloroquine remains an important treatment for conditions such as lupus and rheumatoid arthritis, so you should not stop taking it without medical advice. In the UK, annual retinal monitoring is generally recommended after five years of treatment if you have no additional risk factors. Monitoring may begin earlier if you take more than 5 mg\/kg\/day, use tamoxifen or have reduced kidney function.<\/p>\n

What Is Hydroxychloroquine?<\/h2>\n

Hydroxychloroquine is a medicine that helps control inflammation and immune activity. You may be prescribed it for conditions such as lupus, rheumatoid arthritis or certain skin conditions, and it is often used as a long-term treatment when clinically appropriate.<\/p>\n

Hydroxychloroquine is related to chloroquine, but it generally has a lower risk of retinal toxicity. If you take hydroxychloroquine, you should know your dose and how long you have been taking it, as these factors can affect when you need eye monitoring.<\/p>\n

How Can Hydroxychloroquine Damage the Retina?<\/h2>\n

Hydroxychloroquine can gradually damage the light-sensitive cells in your retina, particularly the photoreceptors. The changes usually affect both eyes and can develop around the central retina without causing symptoms you notice.<\/p>\n

Your eyes may look normal during a routine examination even when early damage is present. If you take hydroxychloroquine long term, specialised tests such as OCT can help your eye specialist detect changes early, before significant sight loss develops.<\/p>\n

How Common Is Hydroxychloroquine Retinal Toxicity?<\/h2>\n

Your risk depends mainly on how long you take hydroxychloroquine and the dose you receive. An influential long-term study found evidence of hydroxychloroquine retinopathy in about 7.5% of people who had taken the medicine for at least five years, although individual risk varied substantially with dose and treatment duration.<\/p>\n

Early retinal changes can occur before you notice symptoms or significant loss of vision. If you take hydroxychloroquine long term, regular monitoring can help your eye specialist detect early changes before significant damage develops.<\/p>\n

Research Insight<\/strong><\/p>\n

One influential study examined 2,361 people who had used hydroxychloroquine continuously for at least five years. Overall retinal-toxicity prevalence was 7.5%, but risk varied substantially according to dose and treatment duration.<\/p>\n

Among people taking approximately 4\u20135 mg\/kg\/day, prevalence remained below 2% during the first 10 years but approached 20% after 20 years of treatment. Kidney disease and concurrent tamoxifen treatment were also associated with increased risk. These are population-level findings and do not predict exactly what will happen to an individual patient.<\/p>\n

Why Does Your Hydroxychloroquine Dose Matter?<\/h2>\n

Your daily hydroxychloroquine dose affects your risk of retinal toxicity. UK guidance uses a \u201c5 \u00d7 5\u201d rule: ideally, your daily dose should remain below 5 mg per kg of actual body weight, with routine monitoring generally beginning after five years.<\/p>\n

This is not a completely safe cut-off, as you can still develop toxicity at lower doses. If your weight changes significantly or you are unsure about your dose, you should ask your doctor or pharmacist to review it rather than changing your treatment yourself.<\/p>\n

Why Does the Length of Treatment Increase the Risk?<\/h2>\n

\"\"<\/p>\n

Your risk of hydroxychloroquine retinal toxicity increases the longer you take the medicine because exposure builds over time. If you have only recently started treatment, your risk is usually low, provided you do not have other major risk factors.<\/p>\n

Five years does not mean you need to stop treatment. Instead, you should usually have annual retinal monitoring after five years, and the longer you take hydroxychloroquine, the more important it becomes to attend these checks.<\/p>\n

What Other Factors Increase Your Risk?<\/h2>\n

Your risk can increase if you have reduced kidney function, take tamoxifen or use a higher hydroxychloroquine dose. Kidney problems can increase the amount of medicine in your body, while UK guidance considers an eGFR below 60 ml\/min\/1.73 m\u00b2 an additional risk factor.<\/p>\n

If you have one or more of these additional risk factors, annual retinal monitoring may begin after the first year of treatment rather than waiting until five years. If your health changes while you take hydroxychloroquine, you should have regular medical and eye reviews to keep your treatment as safe as possible.<\/p>\n

How Hydroxychloroquine Monitoring Changes With Your Risk<\/h2>\n\n\n\n\n\n\n\n\n\n
Situation<\/strong><\/td>\nWhy it matters<\/strong><\/td>\nUK monitoring consideration<\/strong><\/td>\n<\/tr>\n<\/thead>\n
Hydroxychloroquine for more than 5 years<\/td>\nRisk rises with cumulative exposure<\/td>\nAnnual retinal monitoring is generally recommended<\/td>\n<\/tr>\n
Dose above 5 mg\/kg\/day<\/td>\nHigher daily dose increases retinal-toxicity risk<\/td>\nAnnual monitoring may begin after the first year of treatment<\/td>\n<\/tr>\n
eGFR below 60 ml\/min\/1.73 m\u00b2<\/td>\nReduced kidney clearance can increase exposure<\/td>\nAnnual monitoring may begin after the first year of treatment<\/td>\n<\/tr>\n
Taking tamoxifen<\/td>\nTamoxifen is associated with increased toxicity risk<\/td>\nAnnual monitoring may begin after the first year of treatment<\/td>\n<\/tr>\n
No major additional risk factors and treatment under 5 years<\/td>\nRetinal toxicity is uncommon early in treatment<\/td>\nRoutine baseline retinal monitoring is not currently recommended for new hydroxychloroquine users under UK guidance<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

What Symptoms Can Hydroxychloroquine Retinopathy Cause?<\/h2>\n

Early hydroxychloroquine retinopathy often causes no symptoms, so you may not realise your retina is being affected. When symptoms develop, you may notice blurred vision, difficulty reading or areas of missing or altered vision around the centre of your sight.<\/p>\n

Blurred vision does not always mean you have retinal toxicity, as dry eyes, cataracts or changing prescriptions can also affect your sight. However, if you notice persistent or unexplained changes, you should speak to a healthcare professional rather than waiting for your next routine eye check.<\/p>\n

What Does “Bull’s-Eye Maculopathy” Mean?<\/h2>\n

Bull’s-eye maculopathy describes a ring-like pattern of retinal damage around the centre of the retina. If you take hydroxychloroquine, you should know that this appearance is usually linked to more advanced toxicity affecting the retinal pigment epithelium and photoreceptors.<\/p>\n

Modern screening aims to detect toxicity much earlier, before this obvious pattern develops. You do not need to wait for bull’s-eye changes to appear, as OCT and fundus autofluorescence can identify subtle changes before you notice symptoms, helping your eye specialist detect damage at an earlier stage.<\/p>\n

Myth vs Fact<\/h2>\n\n\n\n\n\n\n\n\n\n\n
Myth<\/strong><\/td>\nFact<\/strong><\/td>\n<\/tr>\n<\/thead>\n
Hydroxychloroquine will eventually damage everyone’s eyes.<\/td>\nNo. Retinal toxicity affects only a proportion of long-term users, and risk depends strongly on dose, duration and individual risk factors.<\/td>\n<\/tr>\n
You will notice symptoms as soon as retinal toxicity starts.<\/td>\nNo. Early toxicity is commonly symptom-free, which is why specialised retinal monitoring is important.<\/td>\n<\/tr>\n
A normal sight-chart test means your retina is unaffected.<\/td>\nNot necessarily. Early toxicity may be detectable on OCT or FAF before your central visual acuity changes.<\/td>\n<\/tr>\n
Bull’s-eye maculopathy is the first sign of hydroxychloroquine toxicity.<\/td>\nNo. Bull’s-eye maculopathy is generally a later manifestation. Modern monitoring aims to identify much subtler retinal changes earlier.<\/td>\n<\/tr>\n
One abnormal OCT automatically means you should stop hydroxychloroquine.<\/td>\nNo. UK guidance distinguishes possible from definite toxicity and seeks confirmation before an important long-term treatment is changed.<\/td>\n<\/tr>\n
If toxicity is confirmed, you should stop hydroxychloroquine yourself immediately.<\/td>\nNo. The result should be discussed with your prescribing specialist, who can balance the retinal risk against the need to control your underlying condition.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Does Hydroxychloroquine Damage the Same Part of the Retina in Everyone?<\/h2>\n

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Not always. You may develop parafoveal toxicity, which affects the retina close to the centre of the macula, while other people develop a pericentral pattern farther from the centre. This variation means you should have screening that checks enough of the retina to detect different patterns of damage.<\/p>\n

Modern monitoring therefore uses imaging that can assess more than just the very centre of your retina. OCT and other retinal tests can help your eye specialist identify subtle changes in both parafoveal and pericentral areas, reducing the chance that early toxicity is missed.<\/p>\n

When Should Hydroxychloroquine Eye Monitoring Begin in the UK?<\/h2>\n

In the UK, you will usually have annual retinal monitoring after five years of hydroxychloroquine treatment if you have no additional risk factors. You may need monitoring earlier if you take more than 5 mg\/kg\/day, use tamoxifen or have reduced kidney function, with annual checks potentially starting after one year.<\/p>\n

Routine baseline retinal testing is not currently recommended for everyone starting hydroxychloroquine under UK guidance, although recommendations differ internationally. If you are treated in the UK, you should follow the monitoring schedule arranged by your prescribing and ophthalmology teams, who can refer you into the appropriate screening pathway.<\/p>\n

UK Guidance Note<\/strong><\/p>\n

Current Royal College of Ophthalmologists guidance recommends annual retinal monitoring after five years of hydroxychloroquine treatment for people without additional risk factors. Monitoring may begin earlier when important risk factors are present, including a daily dose above 5 mg\/kg of actual body weight, tamoxifen use or reduced kidney function with an eGFR below 60 ml\/min\/1.73 m\u00b2.<\/p>\n

Routine baseline retinal testing is not currently recommended for everyone starting hydroxychloroquine in the UK. This differs from some international guidance, so the monitoring schedule you are offered may depend on where you receive your care.<\/p>\n

What Happens During Hydroxychloroquine Retinal Monitoring?<\/h2>\n

Your UK monitoring usually involves specialised retinal imaging rather than just checking how well you can read a sight chart. UK monitoring generally includes both spectral-domain OCT and fundus autofluorescence (FAF), with widefield FAF used where available.<\/p>\n

These tests are non-invasive and do not involve surgery or injections. If your OCT and FAF results are normal, no further testing is usually required until your next annual monitoring visit. If either scan shows a possible abnormality, additional functional testing may be needed before toxicity is confirmed.<\/p>\n

What Does an OCT Scan Look for?<\/h2>\n

An OCT scan creates detailed cross-sectional images of your retinal layers. It can help detect early hydroxychloroquine-related changes before you notice symptoms.<\/p>\n