Bull's eye maculopathy
     
    .
    The macula shows an area of hyperpigmentation in the fovea which is surrounded by a zone of depigmentation. 
    The depigmented zone is in turn surrounded by an annulus of hyperpigmentation. The appearance is that of a 
    bull's eye maculaopathy (a better descriptive term is a dartboard appearance but the examiner(s) will probably 
    prefer to hear the conventional description).

    Further examination:

    • Look for evidence suggesting the use of hydroxychloroquine/chloroquine. The signs include vortex 

      • keratopathy and cataract.
    • Look for any systemic illnesses which require the use of hydroxychloroquine/chloroquine. The most 

      • common conditions are rheumatoid arthritis (rheumatoid hands, nodules at the elbow) and systemic lupus 
      erythematosus (butterfly rash on the face)
    Note: Bull's maculopathy can be caused by a variety of conditions (see question below) and is not confined to 
    (hydroxy)chloroquine toxicity. 
    .

    Questions:

    1. What conditions can give rise to bull's eye maculoapthy?

    2. What doses of chloroquine and hydroxychloroquine are associated with bull's eye maculopathy?

    3. In patient taking chloroquine or hydroxychloroquine what changes may occur before the development of bull's eye maculopathy?

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