In short
Hydroxychloroquine eye screening uses retinal scans and a central visual field test to find damage to the macula before it affects sight. A baseline check is done in the first year, and annual screening is recommended once treatment passes five years.
Reviewed by Dr. Ashish Baweja, DM Clinical Immunology & Rheumatology, AIIMS Rishikesh · last updated October 2026
Hydroxychloroquine eye screening is a set of retinal scans done at planned intervals. It is not the eye test you have for spectacles, and it is not done because something has gone wrong. It exists because hydroxychloroquine can, in a small number of long-term users, affect the macula, the central part of the retina you read and recognise faces with.
The earliest changes cause no symptoms at all. By the time vision is noticeably affected, the damage is established, and it does not reverse. Screening is how that is avoided: scans find the change while it is still silent, and the treatment plan can then be reviewed.
None of this makes hydroxychloroquine a dangerous drug. It is one of the best tolerated long-term medicines in rheumatology, and for many people with lupus it is the drug that keeps everything else quiet. Screening is simply the condition on which it is taken for years at a time.
What hydroxychloroquine is for, and why people stay on it
Hydroxychloroquine began as an antimalarial and was found decades ago to calm autoimmune inflammation. It is now used in lupus, in rheumatoid arthritis, and in Sjogren's syndrome (MedlinePlus).
It works slowly. Nobody feels better in a week, and several weeks to a few months is the usual wait before the effect is clear. That slow build is part of why it is prescribed for the long run rather than for a flare.
In lupus it is generally continued indefinitely, because the disease flares less often on it and because it usually allows a lower steroid requirement. Why steroid doses are brought down explains what is gained by that. It is also one of the few rheumatology drugs usually continued during pregnancy, which comes up in planning a pregnancy with lupus.
What the drug can do to the retina
Hydroxychloroquine gradually accumulates in the pigment layer at the back of the eye. In a minority of people taking it for years, that accumulation damages the photoreceptors around the macula, in a ring pattern that spares the very centre until late.
The practical consequence of that pattern is cruel. Central sharpness stays normal for a long time, so your reading vision feels fine while a ring of retina around it is being lost. People notice only when the damage reaches the middle, and by then nothing can be repaired. MedlinePlus describes these as serious and potentially irreversible eye problems, which is why regular eye examinations are part of taking the drug (MedlinePlus).
Hydroxychloroquine retinopathy is uncommon, particularly in the first few years. The risk is not zero, it rises with the number of years of treatment, and it is detectable long before it matters. Those three facts together are the entire argument for screening.
Corneal deposits are a different matter. A few people develop fine deposits in the cornea, the clear window at the front of the eye, which can cause haloes around lights at night. These are usually harmless, generally fade if the drug is stopped, and have nothing to do with the retina. Finding them does not mean retinopathy is developing.
Why hydroxychloroquine eye screening is not a routine eye test
A visit to an optician checks whether you need glasses, measures eye pressure and looks at the back of the eye. That is a useful examination and it will not pick up early retinal toxicity.
Screening needs specific tests: a central visual field test, and dilated imaging of the retina with a scan that shows its layers in cross-section and a photograph that shows where cells are under stress. The Royal College of Ophthalmologists sets out that combination as the screening protocol (Royal College of Ophthalmologists recommendations, via PMC).
So when you book, do not ask for an eye check-up. Say that you take hydroxychloroquine, say for how long, and ask for retinal screening for hydroxychloroquine retinopathy. That phrasing gets you to a department with the right machines instead of a spectacle prescription.
Who needs screening, and when it starts
A baseline before or soon after starting. For anyone expected to take the drug long term, a baseline examination is recommended ideally within six months of starting and certainly within twelve, using colour photographs of the retina and an OCT scan. The point of a baseline is comparison: some people already have macular changes from something else entirely, and finding that out later would confuse everything.
Annual screening once you pass five years. The recommendation is that everyone who has taken hydroxychloroquine for more than five years has annual eye screening for retinopathy. People with additional risk factors may be started on annual screening earlier, a decision for the ophthalmologist after the baseline visit.
The NHS puts the same principle more briefly: if you have been taking hydroxychloroquine for a long time, or are at higher risk of eye problems, you will have regular eye check-ups to look for signs of retinopathy (NHS).
In practice, hydroxychloroquine eye screening is arranged by referral from the doctor who prescribes the drug to an ophthalmologist or eye department equipped for it. It helps if the referral states the date you started the drug, your current weight and your most recent kidney function result, because the eye team uses all three to interpret what they see.
What raises the risk
- Years of treatment. Duration is the single biggest factor, which is why the five-year mark changes the screening interval.
- Dose relative to your body weight. This is why your weight is recorded and rechecked, and why weight loss can matter to a prescription that has not changed.
- Reduced kidney function. The drug is cleared more slowly, so it accumulates faster.
- Tamoxifen taken at the same time. A recognised interaction that raises retinal risk.
- Existing macular disease. Age-related macular degeneration or a scarred macula makes both the risk and the monitoring more complicated.
A large cohort study of long-term users found that increasing age, female sex, chronic kidney disease of stage three or greater, and tamoxifen use were each associated with a higher risk of hydroxychloroquine retinopathy (JAMA Network Open study, via PMC). Kidney function is one of the things being watched in your routine bloods, which rheumatology blood tests explained covers in more detail.
The tests themselves, and what each one shows
The 10-2 visual field test. You look at a central point and press a button whenever a small light appears anywhere in your central vision. It maps the exact area hydroxychloroquine affects first. It takes concentration, and being tired makes the result less reliable, so it is worth going at a time of day when you are fresh.
The OCT scan. A light-based scan that produces a cross-section of the retina, layer by layer, without touching the eye. Thinning of the outer retinal layers in a ring around the macula is the early structural sign.
Widefield fundus autofluorescence. A photograph that shows which areas of the retinal pigment layer are under stress, often before structural thinning is obvious.
If the field test is difficult for you, say so rather than guessing your way through it. Poor concentration, a dry eye or a drooping lid all produce results that look abnormal and are not. An unreliable test is worth repeating on a different day, and the eye team would far rather repeat it than act on a bad reading.
The imaging is done after dilating drops, so expect blurred vision and light sensitivity for a few hours afterwards. Bring sunglasses, and arrange not to drive yourself home. None of it hurts and none of it involves an injection.
What the result means
Results are read together rather than one at a time. No abnormality on any test means no toxicity. An abnormality on one test alone, with the others normal, is called possible toxicity and usually means the tests are repeated rather than anything changing immediately. Definite toxicity means two tests agree, one of them a test you take part in and one of them an objective scan.
That grading exists because single tests mislead. A visual field test can be abnormal because someone was tired, and a scan can look odd for reasons that have nothing to do with the drug. Two independent findings pointing the same way are much harder to dismiss.
Ask for copies of the images and the numbers, not only the summary line. The next round of hydroxychloroquine eye screening is an exercise in comparison, and comparison is far easier when last year's scan is sitting in the same folder.
If a change is found
The decision about what happens to the prescription is made between your ophthalmologist and your rheumatologist, taking into account how active your disease is and what else could hold it. This is not a decision to make on your own after reading a report, and stopping an effective drug abruptly has consequences of its own. Speak to your rheumatologist before changing anything.
If hydroxychloroquine is reviewed, the conversation moves to what replaces it. For lupus and for inflammatory arthritis there are several options, and the treatments used in rheumatology sets out the broad categories. The relevant point is that a flare of uncontrolled disease is also harmful, so nothing is removed without a plan for what follows.
Retinal damage that has already occurred does not heal. Stopping limits further loss rather than restoring what has gone, which is the whole reason screening looks for silent change rather than waiting for symptoms.
Symptoms that should not wait for the next screening date
Book an eye appointment sooner than planned if you notice any of these while taking hydroxychloroquine:
- Gaps or blurred patches in central vision, or words disappearing in the middle of a line as you read.
- Difficulty adjusting between bright and dim light, or new glare from headlights at night.
- Colours looking washed out or different between the two eyes.
Sudden loss of vision is different, and it is an emergency. It is not the pattern hydroxychloroquine causes, and it needs same-day assessment rather than an appointment. In anyone with, or suspected of having, giant cell arteritis, sudden visual loss or a curtain across the vision must be treated as an emergency immediately, because the window to protect the other eye is measured in hours.
Arranging it around a clinic visit
Screening is easiest to keep up with when it is attached to something already in the diary, such as your annual rheumatology review.
- Note the date you started hydroxychloroquine. If you do not know it, the first prescription in your old file usually settles it.
- Take your recent kidney function report and your current weight with you.
- Take any previous retinal images, on a disc or as a file, not just the report.
- List every other medicine you take, including tamoxifen and anything bought without a prescription.
- Book the appointment for a time when you can be driven home afterwards.
Put the date of the next hydroxychloroquine eye screening into your phone before you leave the eye clinic, and add a reminder a month ahead so there is time to book. Appointments for scans fill up, and a screening that drifts by six months every year eventually drifts by years.
Go even when your vision feels perfect, because that is exactly the situation screening is designed for. If a year has quietly slipped past without a check, raise it at your next rheumatology visit and ask for the referral to be made then rather than waiting for the one after.
Common questions
Does hydroxychloroquine always damage the eyes?
No. Retinal damage is uncommon and is rare in the first few years of treatment. The risk rises the longer the drug is taken, which is why screening intervals change after five years. Most people take hydroxychloroquine for many years with normal scans throughout.
How often do I need eye screening on hydroxychloroquine?
A baseline examination is advised in the first year of treatment, ideally within six months. After five years of treatment, annual screening is recommended. People with reduced kidney function, existing macular disease or certain other medicines may be screened annually from an earlier point.
Can my usual optician do this screening?
Only if they have the equipment for retinal imaging and central visual field testing. A standard spectacle check will not detect early changes. Say clearly that you take hydroxychloroquine and need screening for retinopathy, so the appointment is booked in a department set up for it.
What happens if the screening result is abnormal?
One borderline test usually means repeating the tests rather than changing anything. If two tests agree, your ophthalmologist and rheumatologist decide together what happens to the prescription and what could replace it. Do not stop the medicine on your own after reading a report.
Sources
- NHS - Hydroxychloroquine medicine information www.nhs.uk
- MedlinePlus - Hydroxychloroquine drug information medlineplus.gov
- Eye (PMC) - Royal College of Ophthalmologists screening recommendations pmc.ncbi.nlm.nih.gov
- JAMA Network Open (PMC) - Risk factors for hydroxychloroquine retinopathy pmc.ncbi.nlm.nih.gov
This article is general information and does not replace a consultation.