She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Plaquenil synthesist What does plaquenil do to the immune system An electroretinogram showed bilateral absent or grossly reduced rod function and grossly reduced cone function. An OCT scan demonstrated the previously described “flying saucer” sign observed in patients with hydroxychloroquine-induced maculopathy. SD-OCT enables the detection of early loss in external layers and lines, remaining intact below the fovea the flying saucer sign. In 10% of HCQ early toxicity cases, the most specific and objective test SD-OCT could yield false negatives, and for this reason it is important to combine this test with visual field. Plaquenil maculopathy is an uncommon side effect of the systemic medication, Hydroxychrloroquine. This lecture will guide the optometrist in diagnosis and management of Plaquenil maculopathy. The course will review updated guidelines from the American Academy of Ophthalmology and discuss exciting new research utilizing OCT. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Flying saucer sign oct plaquenil SD-OCT As screening test for hydroxychloroquine retinopathy., SD-OCT as screening test for hydroxychloroquine retinopathy. Common side effects of plaquenil In SD-OCT, the so-called “flying saucer sign” can be seen in these patients. This sign is caused by the loss of the perifoveal ellipsoid line, perifoveal thinning of the external nuclear layer and an apparent posterior displacement of the external retina structures towards the pigment epithelium, combined with the preservation of the ellipsoid line in the foveal region, producing said flying saucer sign. 5, 6 Signs of hydroxychloroquine toxicity in a patient with.. Pacific University College of Optometry. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. SD-OCT As screening test for hydroxychloroquine retinopathy The flying saucer sign Article in Archivos de la Sociedad Espanola de Oftalmologia 907 November 2014 with 164 Reads Sep 15, 2014 Chen E, Brown DM, Benz M, et al. Spectral domain optical coherence tomography as an effective screening test for hydroxychloroquine retinopathy the “flying saucer” sign. Clin Ophthalmol. 2010 Oct 21;51-8. In this case, the OCT demonstrates the characteristic loss of the PIL that spares the fovea, known as the flying saucer sign. Dilated fundus exam showed a large, symmetrical area of pigment dropout and mottling across the maculae and into the posterior pole, with small, crystalline deposits in this area in both eyes.