How would you approach a patient who has well controlled SLE on HCQ but develops cotton wool spots on routine ophthalmologic screening?  

Cotton-wool spots are estimated to occur in 10-15% of SLE patients. Etiology is either thrombotic pathology from associated APS, vasculitis or atherosclerosis. Treatment is targeted to the underlying etiology: eg anti-coagulation for APS, immunosuppression for vasculitis or minimization of atheroscl...

Agree 100% with above, especially the emphasis on the CVD risk modification. and heavily emphasize that SLE is as much a risk factor for CVD as diabetes mellitus. I also vote for continuing HCQ. As you know, HCQ retinopathy manifests as a restricting visual field. CWS would not impact dx of it, mak...

A key part of this question is finding cotton wool spots (CWS) in an SLE patient who is well-controlled on HCQ. When we see CWS in a newly diagnosed patient, then we always worry about retinopathy due to the things well outlined by Dr. @Bonnie Bermas above. In an SLE patient in remission, though, th...