OOMC News

A 34 year old woman was referred to screen for Plaquenil toxicity. Medical history is significant for Lupus, for which she has used Plaquenil for 5 years. Ocular history is significant for hereditary drusen. On examination VA was OU: 20/20. The anterior segment was normal. OCT and VF testing were normal (see below). DFE of the macula showed mild bilateral drusen without atrophy or exudation. The peripheral retina of the right eye had the following finding:

The patient had no sign of Plaquenil toxicity. This is a rare occurrence but we generally screen for it with OCT every six months and 10-2 visual field testing yearly. She had mild hereditary drusen which are generally not pathologic. Unrelated to either, she had an unusual retinal lesion in the periphery of OD. The lesion is an intraretinal cavernous hemangioma. From a systemic perspective, this can occasionally be part of systemic hemangiomatosis. Imaging of the brain and abdomen are suggested to rule out other lesions. From an ocular perspective, the lesion often remains stable indefinitely. Occasionally the blood vessels can rupture leading to vitreous hemorrhage. As opposed to capillary hemangiomas of the retina, which are often associated with Von Hippel Lindau disease, these rarely become exudative. The best course of treatment is careful observation. The patient will return for Plaquenil checks every six months and the retinal lesion will be monitored.