In patients with systemic lupus erythematosus (SLE) who develop hydroxychloroquine-induced retinopathy, the appropriate treatment requires immediate discontinuation of hydroxychloroquine to prevent further retinal damage NICE CKS. Following cessation, alternative immunosuppressive therapies are considered necessary to control lupus activity, given the loss of hydroxychloroquine's efficacy and the risk of disease flare NICE CKS. Options may include corticosteroids and other conventional or emerging agents with more favorable ocular safety profiles as indicated by recent studies Luboń et al. 2025.
Hydroxychloroquine cessation is paramount because continuing the drug after retinopathy detection can lead to irreversible vision loss NICE CKS. Since hydroxychloroquine provides significant long-term disease control and organ protection in lupus, clinicians should carefully select alternative treatments to maintain disease suppression without compromising ocular health Luboń et al. 2025. Corticosteroids are often utilized as bridging therapy or to manage active disease, but long-term steroid-sparing agents should be considered to minimize systemic side effects NICE CKS. Emerging biologics or immunosuppressants with less ocular toxicity risk are promising but require careful monitoring Luboń et al. 2025.
In summary, management prioritizes immediate hydroxychloroquine withdrawal, close ophthalmologic monitoring, and initiation of alternative immunosuppressive regimens tailored to disease severity and patient tolerability, integrating established UK guidelines with evolving evidence on ophthalmological safety NICE CKSLuboń et al. 2025.