She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Plaquenil well tolerated Hydroxychloroquine liver Plaquenil vertigo High cost of hydroxychloroquine Cornea verticillata also called vortex keratopathy, whorl keratopathy, or Fleischer vortex describes a whorl-like pattern of golden brown or gray opacities in the cornea. It is termed cornea verticillata from the Latin noun “verticillus,” meaning “whorl”. Manifestation of these corneal deposits is not related to duration, dose, or vision loss and is completely reversible upon discontinuation of the medication. Chloroquine has been associated with keratopathy more than hydroxychloroquine. Older studies have shown a decrease in corneal sensation in approximately 50% of patients taking chloroquine. Cornea verticillata is often caused by the use of certain systemic medications, the most common of which include amiodarone, chloroquine, hydroxychloroquine, indomethacin, and phenothiazenes. Cornea verticillata can also be seen in the sphingolipidosis, Fabry disease. Read the related case report for more information on cornea verticillata Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Hydroxychloroquine corneal verticillata Chloroquine and Hydroxychloroquine Toxicity Clinical Presentation, Chloroquine and Hydroxychloroquine Toxicity Clinical. Alternative meds than plaquenilChloroquine prices Cornea • Retina Quick sidebar •Corneal verticillata whorl keratopathy •“ hloroquine, and less frequently HCQ, can cause whorl-like intraepithelial deposits verticillata in the cornea. These corneal changes are not a direct marker for retinal damage, are not associated with visual loss, and in contrast COPE Disclosures Plaquenil Toxicity Update. Cornea verticillata - Ophthalmology. Hydroxychloroquine Plaquenil Toxicity and Recommendations for Screening. Some degree of corneal deposits verticillata can be demonstrated in most patients taking chloroquine, but these changes very rarely impair vision. 4 Corneal deposits occur more frequently with chloroquine than with hydroxychloroquine, 5 are located in the epithelium and subepithelial stroma 6, 7 and are mostly reversible. 7 By contrast. A number of systemic drugs induce corneal epithelial changes characterized by deposits that might present as a vortex keratopathy described also as whorled or verticillate; thus, the term cornea verticillata or a diffuse corneal haze, punctate keratopathy, or crystalline precipitates. The aminoquinolones chloroquine and hydroxychloroquine have been widely used in the treatment of SLE. These drugs can cause a reversible, visually insignificant keratopathy cornea verticillata and, more importantly, an irreversible sight-threatening maculopathy. Clinical progression is of loss of the foveal reflex followed by a fine granular.