Aims To assess the characteristics and outcomes of patients with hydroxychloroquine retinopathy and to review the current screening guidelines.

Methods Retrospective chart review of patients diagnosed as having hydroxychloroquine retinopathy at our institution between 2004 and 2008.

Results All seven patients were women. While every patient received 400 mg of hydroxychloroquine per day, every patient exceeded the recommended daily dosage allowance (6.5 mg/kg/day). The mean daily dose of hydroxychloroquine was 8.2 mg/kg/day (range: 6.8–13.6 mg/kg/day). The mean duration of usage was 16.3 years (range: 8.5–30 years), and the mean cumulative dose was 2377 g (range: 1241–4380 g). The mean visual acuity at presentation was 20/30, but all patients exhibited significant visual-field defects. Colour vision was impaired in six patients. Four patients exhibited granular hyperpigmentation in the central macula, and three had a bull's eye appearance. The mean follow-up time was 21 months. The visual outcomes remained stable for every patient except for one patient who experienced an improvement in visual function after drug cessation.

Conclusions Hydroxychloroquine retinopathy, although rare, still exists despite current screening guidelines. The authors recommend that physicians dose hydroxychloroquine according to lean body weight and that they use risk stratification to guide their screening regimens.