Hydroxychloroquine (HCQ) has been widely used for treatment of various rheumatic and dermatologic diseases. However, under a high cumulative dose, HCQ may cause retinal toxicity. In this review, we summarize the underlying mechanisms, prevalence, risk factors, clinical characteristics, screening tests, treatments, and prognosis of HCQ retinopathy. Because HCQ retinopathy is rarely reversible, screening tests to determine the retinal toxicity prior to its development are important. The American Academy of Ophthalmology screening protocols for early detection were updated in 2013. However, as a different clinical type is found in Asian patients, predominantly the pericentral type of photoreceptor damage, rather than the traditional parafoveal type, we propose a modified screening protocol for detection of HCQ retinopathy in Korean and other Asian patients.