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 1. 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 1. 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 1. 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 1. 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 1Luboń et al. 2025.