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Patients with retinal changes may have visual symptoms or may be asymptomaticwith or without visual field changesRarely scotomatous vision or field defects may occur without obvious retinal change.

Retinopathy appears to be dose related and has occurred within several monthsrarelyto several years of daily therapya small number of cases have been reported several years after antimalarial drug therapy was discontinuedIt has not been noted during prolonged use of weekly doses of the 4aminoquinoline compounds for suppression of malaria.

There may be an interaction between hydroxychloroquine and any of the following:

The methods recommended for early diagnosis ofchloroquine retinopathyconsist of1funduscopic examination of the macula for fine pigmentary disturbances or loss of the foveal reflex and2examination of the central visual field with a small red test object for pericentral or paracentral scotoma or determination of retinal thresholds to redAny unexplained visual symptomssuch as light flashes or streaksshould also be regarded with suspicion as possible manifestations of retinopathy.

Suicidal behavior has been reported in very rare cases in patients treated with hydroxychloroquine.

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