1️⃣ Hydroxychloroquine Retinopathy ✅ The most critical indication in rheumatology 🔹 OCT detects: — Parafoveal thinning — Loss of ellipsoid zone (photoreceptor integrity) — Foveal sparing in early stages 💡 Annual OCT screening after 5 years of HCQ therapy (earlier if high

2️⃣ SLE Retinopathy 🔹 Microvascular ischemia can cause: — Cotton wool spots — Macular edema — Retinal thinning ✅ OCT identifies macular edema and ischemia before vision loss.

3️⃣ Uveitis in Spondyloarthritis, Sarcoidosis, Behçet’s Disease 🔹 OCT shows: — Macular edema — Vitreomacular traction — Epiretinal membranes 💡 Essential for monitoring posterior uveitis.

4️⃣ Retinal Vasculitis (ANCA Vasculitis, SLE, Behçet’s) 🔹 OCT detects: — Cystoid macular edema — Serous retinal detachment — Inner retinal thinning

5️⃣ Giant Cell Arteritis (GCA) 🔹 Can cause anterior ischemic optic neuropathy ✅ OCT demonstrates: — Optic nerve head swelling — Retinal nerve fiber layer thickening 💡 Helps differentiate arteritic vs. non-arteritic causes.

6️⃣ Sjögren’s Syndrome 🔹 OCT may reveal: — Subclinical macular thinning — Retinal nerve fiber layer loss

🩺 Practical Tips: ✅ Always ask about visual symptoms in patients on HCQ, steroids, or with vasculitis. ✅ Baseline OCT before HCQ in high-risk patients: — Age >60 — Renal impairment — >5 mg/kg dosing ✅ Repeat annually or sooner if symptoms arise.

Pearl: OCT allows early detection of irreversible retinal damage—a simple test with a big impact. #Rheumatology #Ophthalmology #AutoimmuneDisease #Hydroxychloroquine #MedEd #FOAMed #RheumTwitter #MedTwitter

@Rheumat_Aravind OCT does not identify ischemia. It gives quantitative data. Also differentiating arteritic from non arteritic AION is largely clinical. OCT must always be interpreted in association with an ophthalmologist.