Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 18 peer-reviewed journal articles Updated
Rheumatology · Retinal Toxicity

What Are the Eye Side Effects of Hydroxychloroquine?

At a Glance

While long-term use of hydroxychloroquine (Plaquenil) can cause retinal toxicity, severe vision loss is extremely rare. Protect your eyes by ensuring your dose is strictly weight-based (under 5 mg/kg) and getting specialized SD-OCT eye screenings starting in your fifth year of treatment.

In this answer

5 sections

01

Why Hydroxychloroquine is Foundational for Lupus

02

The Truth About Retinal Toxicity

03

How to Protect Your Eyes

04

The Importance of Catching It Early

05

Additional Risk Factors

Will taking hydroxychloroquine (Plaquenil) make you go blind? The short answer is no, this is extremely unlikely. While it is true that hydroxychloroquine can affect the retina (the light-sensitive tissue at the back of the eye) over time, severe vision loss is rare. By taking the correct weight-based dose and adhering to a specific screening schedule, any changes can be detected safely long before they affect your vision.

Why Hydroxychloroquine is Foundational for Lupus

Before worrying about side effects, it is helpful to understand why your rheumatologist prescribed this medication. Hydroxychloroquine is considered a “foundational” therapy for systemic lupus erythematosus (SLE) [1][2]. It is life-saving and works quietly in the background to prevent lupus flares [3][4], protect your organs from damage, and even reduce the risk of mortality [5][6]. Because of these substantial benefits, doctors strongly recommend it for almost everyone with lupus.

The Truth About Retinal Toxicity

The eye-related side effect most associated with hydroxychloroquine is called retinal toxicity. This happens when the medication slowly builds up and damages the outer layers of the retina, particularly the light-detecting cells in the center of the eye [7][8].

However, the most important thing to know is that this side effect is cumulative, meaning it heavily depends on how much of the medication you take over many years [9]. The risk of retinal toxicity is very low during the first 5 to 10 years of taking the drug.

How to Protect Your Eyes

There are two critical steps to ensuring your eyes remain healthy while taking hydroxychloroquine:

  • Proper Dosing: The American Academy of Ophthalmology (AAO) recommends a daily dose of 5 milligrams (or less) per kilogram of your actual body weight [10][11]. For example, if you weigh 150 lbs (about 68 kg), your maximum daily dose would be about 340 mg. Because pills usually come in 200 mg sizes, your doctor might have you alternate between taking one pill and two pills on different days. Note that doctors also typically cap the total daily dose at 400 mg per day, regardless of your weight.
  • Specialized Screenings on the Right Timeline: A standard eye exam for glasses is not enough. You need advanced screening that includes spectral-domain optical coherence tomography (SD-OCT) (a highly detailed structural scan of the retina) and visual field (VF) testing (which checks for blind spots) [12][13].

The AAO Screening Timeline:
You do not need these advanced tests every single year from day one unless you have major risk factors. The official guideline is to get a baseline exam within your first year of starting the drug. After that, your annual screenings begin at year 5 [13][10].

The Importance of Catching It Early

These advanced tests are designed to catch microscopic, structural changes in your retina before you experience any noticeable changes to your vision [14][7]. If your eye doctor notices these early signs of toxicity, they will coordinate with your rheumatologist to stop the medication.

Because the drug stays in the body for a long time, damage can progress slightly even after stopping [15]. However, because the SD-OCT tests catch the damage at a microscopic level, stopping the medication immediately ensures that the progression halts long before it ever affects your actual ability to see.

Additional Risk Factors

Certain factors can increase your risk of developing retinal toxicity, requiring you to start annual screening before year 5:

  • Kidney disease: Since hydroxychloroquine is cleared by the kidneys, poor kidney function can lead to higher levels of the drug in your body [16][11].
  • Tamoxifen use: Taking this breast cancer medication alongside hydroxychloroquine significantly increases the risk of toxicity, requiring closer monitoring [13].
  • Ancestry: Patients of Asian descent may experience retinal changes in a slightly different part of the eye, meaning the eye doctor needs to scan a wider area of the retina to ensure accurate screening [17][18].

Common questions in this guide

Will taking hydroxychloroquine (Plaquenil) make me go blind?
Severe vision loss or blindness from hydroxychloroquine is extremely rare. By following proper weight-based dosing and getting advanced annual eye screenings starting in your fifth year, any microscopic damage can be caught and stopped long before it affects your vision.
How much hydroxychloroquine is safe for my eyes?
The American Academy of Ophthalmology recommends a maximum daily dose of 5 milligrams or less per kilogram of your actual body weight. Doctors also typically cap the total daily dose at 400 mg per day, regardless of weight, to minimize the risk of eye damage.
What kind of eye exam do I need while taking Plaquenil?
A standard eye exam for glasses is not enough. You need advanced screenings that include spectral-domain optical coherence tomography (SD-OCT) to scan the retina's physical structure, along with visual field testing to check for early blind spots.
When should I start getting annual eye exams for hydroxychloroquine?
The official guideline is to get a baseline eye exam within your first year of starting the medication. Unless you have specific risk factors like kidney disease, your routine annual eye screenings should begin after five years of taking the drug.
Do other medical conditions or medications increase my risk for retinal toxicity?
Yes, certain factors can increase your risk and require closer monitoring. Having kidney disease can lead to higher levels of the drug in your body, and taking the breast cancer medication tamoxifen alongside hydroxychloroquine significantly increases the risk of toxicity.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Am I currently taking a dose of hydroxychloroquine that is under 5 mg per kilogram of my actual body weight, based on my most recent weigh-in?
  2. 2.Given my medical history (such as kidney function or other medications), do I follow the standard screening timeline of a baseline exam then starting annuals at year five, or do I need them sooner?
  3. 3.Can you refer me to an ophthalmologist who is familiar with the latest American Academy of Ophthalmology guidelines and has the equipment to perform both SD-OCT and visual field testing?
  4. 4.If I lose or gain weight, how much of a change should prompt us to re-calculate my daily dose?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Can You Have a Normal Pregnancy with Lupus?Does a Positive ANA Test Mean I Have Systemic Lupus?Does Lupus Increase Your Risk of Heart Disease?How Does Lupus Affect Black and Hispanic Populations?How Long Do You Have to Take Prednisone for Lupus?What Are the Emergency Symptoms of Lupus?What Causes a Lupus Flare-Up? Symptoms & TriggersWhat Causes Lupus Brain Fog & How Is It Managed?What Does Foamy Urine Mean With Lupus? Key Warning SignsWhat Is Secondary Sjögren's in Lupus? | Inciteful MedHow Does Childhood-Onset Lupus Differ from Adult Lupus?Cutaneous vs Systemic Lupus: What is the Difference?What is the Difference Between Lupus and Fibro?What Is the Life Expectancy for Someone With Lupus?Why Does Sun Exposure Trigger Lupus Flares?Why Does Systemic Lupus Take So Long to Diagnose?Why is a Kidney Biopsy Needed for Lupus Nephritis?

References

References (18)
  1. 1

    GNS561 (ezurpimtrostat), a small basic lipophilic molecule, prevents lupus phenotype in a pristane-induced lupus mouse model.

    Toumi E, Bestion E, Militello M, et al.

    British journal of pharmacology 2025; (182(16)):3786-3799 doi:10.1111/bph.70058.

    PMID: 40258389
  2. 2

    Balancing risks and benefits in the use of hydroxychloroquine and glucocorticoids in systemic lupus erythematosus.

    Paredes-Ruiz D, Martin-Iglesias D, Ruiz-Irastorza G

    Expert review of clinical immunology 2024; (20(4)):359-373 doi:10.1080/1744666X.2023.2294938.

    PMID: 38112074
  3. 3

    Risk of flare in patients with SLE in remission after hydroxychloroquine or chloroquine withdrawal.

    Trefond L, Mathian A, Lhote R, et al.

    Joint bone spine 2024; (91(6)):105756 doi:10.1016/j.jbspin.2024.105756.

    PMID: 38964624
  4. 4

    Association Between Severe Nonadherence to Hydroxychloroquine and Systemic Lupus Erythematosus Flares, Damage, and Mortality in 660 Patients From the SLICC Inception Cohort.

    Nguyen Y, Blanchet B, Urowitz MB, et al.

    Arthritis & rheumatology (Hoboken, N.J.) 2023; (75(12)):2195-2206 doi:10.1002/art.42645.

    PMID: 37459273
  5. 5

    Hydroxychloroquine use reduces mortality risk in systemic lupus erythematosus: A systematic review and meta-analysis of cohort studies.

    Cai T, Zhao J, Yang Y, et al.

    Lupus 2022; (31(14)):1714-1725 doi:10.1177/09612033221129774.

    PMID: 36325952
  6. 6

    Effect of immunosuppressive therapies on survival of systemic lupus erythematosus: a propensity score analysis of a longitudinal cohort.

    Mok CC, Tse SM, Chan KL, Ho LY

    Lupus 2018; (27(5)):722-727 doi:10.1177/0961203317739129.

    PMID: 29087260
  7. 7

    Hydroxychloroquine Causes Early Inner Retinal Toxicity and Affects Autophagosome-Lysosomal Pathway and Sphingolipid Metabolism in the Retina.

    Mondal K, Porter H, Cole J, et al.

    Molecular neurobiology 2022; (59(6)):3873-3887 doi:10.1007/s12035-022-02825-3.

    PMID: 35426574
  8. 8

    Classification of Hydroxychloroquine Retinopathy: A Literature Review and Proposal for Revision.

    Ahn SJ

    Diagnostics (Basel, Switzerland) 2024; (14(16)) doi:10.3390/diagnostics14161803.

    PMID: 39202291
  9. 9

    Risk of hydroxychloroquine retinopathy in the community.

    Dabit JY, Hocaoglu M, Moder KG, et al.

    Rheumatology (Oxford, England) 2022; (61(8)):3172-3179 doi:10.1093/rheumatology/keab844.

    PMID: 34788400
  10. 10

    Adaptive optics: a tool for screening hydroxychloroquine-induced maculopathy?

    Babeau F, Busetto T, Hamel C, et al.

    Acta ophthalmologica 2017; (95(5)):e424-e425 doi:10.1111/aos.13276.

    PMID: 27805308
  11. 11

    Risk of Retinal Toxicity in Longterm Users of Hydroxychloroquine.

    Kim JW, Kim YY, Lee H, et al.

    The Journal of rheumatology 2017; (44(11)):1674-1679 doi:10.3899/jrheum.170158.

    PMID: 28864645
  12. 12

    Target in Sight: A Comprehensive Review of Hydroxychloroquine-Induced Bull's Eye Maculopathy.

    Snow Z, Seely K, Barrett S, et al.

    Current ophthalmology reports 2024; (12(3)):38-48 doi:10.1007/s40135-024-00321-6.

    PMID: 39371107
  13. 13

    Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision).

    Marmor MF, Kellner U, Lai TY, et al.

    Ophthalmology 2016; (123(6)):1386-94.

    PMID: 26992838
  14. 14

    Association between hydroxychloroquine intake and damage to the outer nuclear layer in eyes without manifest retinal toxicity.

    Salameh N, Doumit CA, Jalkh E, Nehme J

    BMC ophthalmology 2024; (24(1)):414 doi:10.1186/s12886-024-03684-3.

    PMID: 39334015
  15. 15

    Ellipsoid Zone Hyporeflectivity as an Early Sign of Non-Reversible Hydroxychloroquine Retinopathy: A Case Series.

    Groothoff JD, Browning DJ

    Clinical ophthalmology (Auckland, N.Z.) 2025; (19()):4177-4192 doi:10.2147/OPTH.S554892.

    PMID: 41256870
  16. 16

    Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis.

    Lenfant T, Salah S, Leroux G, et al.

    Rheumatology (Oxford, England) 2020; (59(12)):3807-3816 doi:10.1093/rheumatology/keaa157.

    PMID: 32442312
  17. 17

    Optical coherence tomography characteristics in hydroxychloroquine retinopathy and the correlations with visual deterioration in Taiwanese.

    He SK, Lai TT, Hsieh YT

    Taiwan journal of ophthalmology 2024; (14(4)):565-572 doi:10.4103/tjo.TJO-D-24-00071.

    PMID: 39803390
  18. 18

    Advanced Pericentral Hydroxychloroquine Retinopathy in an Asian Woman.

    Sheth N, Schaab T, Mirza RG

    Journal of vitreoretinal diseases 2020; (4(2)):148-151 doi:10.1177/2474126419885329.

    PMID: 37008381

This page provides educational information about hydroxychloroquine and eye health. Always consult your rheumatologist and ophthalmologist for personalized medical advice, dosing, and screening schedules.

Get notified when new evidence is published on Systemic lupus erythematosus.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.