By when should an eye examination be completed after starting hydroxychloroquine?

• A. Within 6 months
• B. Within 1 year
• C. No later than 5 years after starting
• D. After 10 years

Answer: (C)

Screening for hydroxychloroquine retinopathy is guided by the fact that the drug can cause progressive, irreversible retinal damage that may be asymptomatic early on. The risk accumulates with time and total dose, so an eye examination should be completed by no later than five years after starting therapy. This timing allows a baseline assessment and ensures that, as cumulative exposure increases, vision-threatening toxicity can be detected early. After five years of use, annual screening is typically recommended, with more frequent exams if risk factors are present (such as high daily dose, kidney or liver disease, concurrent tamoxifen use, or pre-existing retinal disease).