Article Text

Download PDFPDF
Hydroxychloroquine retinopathy screening guidelines: a false positive
  1. Tolga Kamil Guven1,
  2. Adam Alexander2 and
  3. Guy T Smith2
  1. 1Ophthalmology, Great Western Hospital Foundation NHS Trust, Swindon, UK
  2. 2Ophthalmology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
  1. Correspondence to Dr Adam Alexander; dralexanderuk{at}


Hydroxychloroquine sulphate (HCQ) is widely used for the treatment of a variety of rheumatological and dermatological conditions. Despite the advantages of HCQ as a treatment option, it is important to be aware of its potential retinal toxicity, which may be irreversible and progressive. In December 2020, The Royal College of Ophthalmologists published revised recommendations on monitoring HCQ retinopathy. Our case report highlights some of the shortcomings of blindly following their monitoring algorithm by presenting a case where apparent HCQ retinopathy resolved after Yttrium Aluminium Garnet (YAG) laser capsulotomy. The case reiterates the importance of thorough clinical examination. We suggest that while the acquisition of the spectral domain optical coherence tomography and fundus autofluorescence may be objective, their interpretation is subjective. Even with the use of artificial intelligence algorithms, false positives may be generated if the tests are confounded by copathology. There is no gold-standard test for detecting HCQ toxicity.

  • Macula
  • Retina
  • Ophthalmology
  • Rheumatology
  • General practice / family medicine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @tolgakguven

  • Contributors TKG: first author and writer. AA: corresponding author, co-author, proof reading, amendments, figure suitability, uploads and submissions. GTS: supervising consultant, topic conception and amendments of the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.