Antimalarials and ophthalmologic safety.

Antimalarial drugs were shown to be useful agents in the treatment of discoid and systemic lupus erythematosus in 1951. However, by 1966, fear of retinal toxicity and the availability of alternative therapies had led to limited use of antimalarials. Continued experience with these alternative therapies has made their intrinsic, sometimes devastating toxicities more evident and has contributed to the renewed interest in antimalarial agents evident in the number of comprehensive reviews appearing recently in the dermatology literature. Many of these reviews, while generally excellent, have propagated some apparent misconceptions by disregarding or de-emphasizing data suggesting that irreversible retinal toxicity due to antimalarials can be easily avoided by judicious daily dosage and regular ophthalmologic follow-up. This article will discuss the historical basis of these misconceptions and the subsequent studies which suggest that antimalarial retinal toxicity can be avoided without sacrificing the therapeutic efficacy of these agents.