Neuro-Ophthalmic Consequences of Therapy

An elderly woman was first seen in 1991, after being on Plaquenil (Hydroxychloroquine Sulfate) for 5 to 6 years, with a new symptomatic disturbance in her reading. Because her blue/yellow color perception was disturbed, and because she had symptoms, the medication was stopped. However the fundi and the fluorescein angiogram did not support Plaquenil toxicity. Two months later, red versus blue central fields on the tangent screen were normal, but on Goldmann, with the 14e isopter, she had small central scotomas. In the summer of 1992, Goldmann fields were normal, but the Amsler showed a central disturbance OD. By the summer of 1994, she had definite bull's eyes in both maculae. The latest acuity is 20/70 in each eye. Imaging of fundus OD. Anatomy: Fundus; Macula. Disease/Diagnosis: Plaquenil toxicity