Nonleaking Cystoid Macular Edema as a Presentation of Hydroxychloroquine Retinal Toxicity

Hydroxychloroquine (HCQ; Plaquenil, Sanofi-Synthelabo, Inc, Paris, France) is used to treat autoimmune diseases such as systemic lupus erythematous and rheumatoid arthritis. With long-term exposure, HCQ is known to cause a toxic retinopathy with rates varying between 1% to as high as 7.5% in patients.1 Funduscopic findings of HCQ retinal toxicity range from early, fine retinal pigment epithelium stippling of the macula to the characteristic bilateral bull's eye maculopathy.1 Cystoid macular edema (CME) has been rarely and briefly described in the literature as associated with HCQ retinal toxicity with differing interpretations regarding the angiographic features of the CME.