Early macular toxicity can cause stippling or mottling of the RPE. Next, granular pigmentation and loss of the normal foveal reflex can occur. It is believed (but not proven) that if early macular changes are detected and the medication is stopped, any toxicity that has occurred can be reversed.¹

If the maculopathy continues to progress, concentric zones of hyperpigmentation and depigmentation (left photo) can form, causing irreversible toxicity. Stopping the medication at his point will not reverse any damage that has occurred. Photo: Bull's eye maculopathy. Courtesy of Jane Ann Grogg, OD, Indiana University School of Optometry.

Later disease findings include peripheral bone spicules, vasculature attenuation, and disc pallor (can mimic retinitis pigmentosa).¹

The corresponding fluoroscein angiography photos from another patient with bull's eye maculopathy are seen below.

Photos courtesy of Jane Ann Grogg, OD Indiana University School of Optometry.

Bull's eye maculopathy is not caused only by antimalarial drugs. Other conditions that can cause bull's eye maculopathy are:

• Progressive cone dystrophy
• Rod-cone dystrophy
• Benign concentric macular dystrophy
• Stargardt's disease
• Batten's disease

	URL: http://www.opt.indiana.edu/ce/plaq/bulls.htm Revised: May 7, 2007
	IU Optometry home page: http://www.opt.indiana.edu/ Comments (content): Dr. Julie Torbit at jtorbit@indiana.edu Comments: Web Administrator Page design and coding: Terri Greene Copyright © 2007, The Trustees of Indiana University