case_images: PMC11182261_01
case_images: Hyperpigmentation of the right and left sclerae, nail beds, and lower extremities on initial presentation (A-C, respectively) and 5 months after cessation of HCQ (D-F, respectively). The arrows in (A, D) highlight areas of scleral discoloration that are found both medially and temporally. Arrows in (B, E) indicate the bluish discoloration of the proximal nailbed, which can be observed in all digits and was slightly improved after 5 months. Arrows in (C, F) depict a patchy, bluish-brown discoloration of the lower extremities, which remained similarly discolored but had slightly receded, as depicted by the arrows.
case_images: fopht-03-1192019-g001.jpg
case_images: PMC11182261_01_fopht-03-1192019-g001.jpg
case_images: f1
case_images: A 75-year-old female presented with a 10-month history of gradual, painless graying discoloration of both sclera, bilateral fingernail beds, and bilateral lower extremities ( Figure 1 ). The slit lamp was notable for 1+ nuclear sclerosis and pinguecula OU, as well as diffuse graying of the sclera OU without associated scleral thinning or masses ( Figure 1 ). The patient was followed up again 5 months after the initial presentation and the color changes had improved slightly ( Figures 1 ,  2 ).
case_images: Timeline of patient's clinical course, from initiation of HCQ to 10 months of gradually worsening hyperpigmentation, followed by discontinuation of HCQ and subsequent slow reversal of discoloration by 5 months after cessation of the drug.
case_images: fopht-03-1192019-g002.jpg
case_images: PMC11182261_01_fopht-03-1192019-g002.jpg
case_images: f2
case_images: The patient was followed up again 5 months after the initial presentation and the color changes had improved slightly ( Figures 1 ,  2 ).