What is Hydroxychloroquine (Plaquenil®)?

Hydroxychloroquine is a medication used to treat inflammatory conditions such as rheumatoid arthritis. In rare cases it can cause visual problems and loss of vision due to eye damage (ocular toxicity).

What are the risks for ocular toxicity?

You have an increased risk of ocular toxicity if you:

  • are on a high dose of Hydroxychloroquine (more than 5mg per day per kilogram of body weight)
  • have been on Hydroxycholorquine for more than five years
  • have kidney disease
  • take the medication Tamoxifen
  • have underlying eye disease affecting the retina (back of the eye).

What are the symptoms of ocular toxicity?

You may not have any visual symptoms. You might notice small areas of blurry or missing vision when you read or use the Amsler grid on the next page.

Loss of vision only occurs late in ocular toxicity.

Why are regular eye exams important?

Damage to the eye through hydroxychloroquine toxicity is not treatable or reversible, so it is important to report any changes in your vision early.

You should have a baseline eye exam within one year of starting ocular toxicity treatment with your eye care provider.

If you are at high risk of toxicity you will need yearly eye exams. If you are at low risk, start yearly eye exams after five years of taking Hydroxycholorquine.

You can monitor your vision by regularly using the Amsler grid on the bottom of this page.

Things to remember

  • Talk to your GP or specialist about your risk of ocular toxicity from Hydroxychloroquine.
  • Know your dose of medication.
  • Have a baseline eye examination within one year of starting Hydroxychloroquine and attend regular screening exams.
  • Contact your eye care provider if you notice any visual symptoms using the Amsler grid.

Amsler grid to monitor your vision

Amsler Grid to monitor vision


  1. Hold the grid at a comfortable distance in good lighting.
  2. If you wear reading glasses, put them on.
  3. Cover one eye and look at the central dot. Note any area where the grid lines are blurred, curved or missing.
  4. Repeat with other eye.
  5. Contact your eye care provider if you notice any blurred, curved or missing lines.

Even if you regularly use this Amsler grid, you should still have the recommended screening eye exams every year.

Disclaimer This document describes the generally accepted practice at the time of publication only. It is only a summary of clinical knowledge regarding this area. The Royal Victorian Eye and Ear Hospital makes no warranty, express or implied, that the information contained in this document is comprehensive. They accept no responsibility for any consequence arising from inappropriate application of this information.

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  • Hydroxychloroquine (Plaquenil®) Ocular Toxicity #228
  • Owner: Ophthalmology
  • Last Reviewed: June 28, 2023
  • Next Review: June 28, 2028