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. Electroretinogram for plaquenil Side effects of plaquenil for lupus All three demonstrated characteristic perifoveal outer retinal abnormalities seen on SD OCT that we have termed the “flying saucer” sign; these findings include preservation of the outer retinal structures in the central fovea, perifoveal loss of the photoreceptor IS/OS junction and outer retinal thinning, posterior or “sinkhole” displacement of the inner retinal structures toward the retinal pigment epithelium, 25 and variable loss of the normal foveal depression. 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. Three patients with early HCQ toxicity and HVF 10-2 perifoveal defects were found to have loss of the perifoveal photoreceptor inner segment/outer segment IS/OS junction with intact outer retina directly under the fovea, creating the “flying saucer” sign. 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 Spectral domain optical coherence tomography as an effective., Pacific University College of Optometry Plaquenil and dental extractions 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.. Spectral domain optical coherence tomography as an effective screening.. SD-OCT As screening test for hydroxychloroquine.. Specifically, SD-OCT can detect loss of the perifoveal photoreceptor inner segment/outer segments line PIL At the macula, an ovoid appearance can appear described as “flying saucer” sign by Chen, et al 18 Repeat 10-2 HVF testing demonstrated the dense paracentral scotomas. SD-OCT showed loss of the parafoveal inner/outer segment junction, thinning of the parafoveal outer nuclear layer, and a loss of the normal foveal depression, which is characteristic for hydroxychloroquine retinal toxicity Figure 3. 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.