Editor,—While the antimalarial drug chloroquine has frequently been reported to cause retinopathy, there have been very few documented cases occurring with hydroxychloroquine (Plaquenil, Winthrop Pharmaceuticals, New York, USA).1-5Patients may tolerate large cumulative doses (up to 3923 g) of hydroxychloroquine without developing retinopathy.1 Doses of ⩽400 mg/day and ⩽6.5 mg/kg of body weight/day of hydroxychloroquine have been used safely and some authors have suggested that ophthalmic screening is not necessary for patients on these doses.3-5 We present a case of hydroxychloroquine toxicity that developed in a patient after long term use of 400 mg (6.3 mg/kg) of hydroxychloroquine daily.