Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Symptoms require assessment outside the screening timetable
New distortion, missing central vision or reduced sight during hydroxychloroquine treatment needs a clinical eye assessment. A future monitoring appointment is not a sufficient response to symptoms, and abrupt painful loss suggests another urgent process.
Action: Clarify onset and severity, arrange urgent ophthalmic advice for new visual change, and use the emergency eye pathway for sudden loss or a painful red eye. Inform the prescriber of suspected toxicity while the diagnosis is clarified.
Synopsis
Select patients for UK retinal monitoring, understand the imaging-led investigation sequence, and act on uncertain or definite toxicity without disrupting necessary systemic treatment.
The UK 2020 Royal College pathway uses OCT and fundus autofluorescence as the initial monitoring tests.
The 2025 BSR guideline recommends annual monitoring after five equivalent continuous years for all hydroxychloroquine users.
Higher-risk patients need annual monitoring after one year under the current BSR recommendation.
Key red flags
A patient with new visual symptoms is waiting months for routine monitoring.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.