Objective: Hydroxychloroquine is a commonly used immunosuppressive agent in the treatment of various autoimmune diseases, despite lesser systemic toxicity compared to other drugs; it can cause severe retinal dysfunction and loss of vision. The aim of this study is to determine the early OCT findings in preclinical Hydroxychloroquine (HCQ) retinopathy. Patients and methods: This cross sectional comparative study held place in Ophthalmology and Rheumatology Clinics, Benha university Hospitals; from March 2019 to April 2021, twenty eyes of rheumatic patients on HCQ for more than two years and other twenty eyes of normal gender matched individuals, all underwent full ophthalmological examination and imaging with Spectral Domain Optical Coherence Tomography (SD-OCT). The entire study group had normal fundus appearance. Results: Outer retinal thinning in the form of central foveal and para-foveal thinning was detected by SD-OCT in patients on chronic HCQ for more than 2 year use with still normal fundus. IS/OS junction was interrupted in only 2 rheumatic patients (10%). Color vision was affected only in three rheumatic patients (15%). Conclusion: Screening of rheumatic patients by SD-OCT can detect preclinical HCQ retinopathy and this could be used as a screening technique especially with the increased availability of SD-OCT machines in most eye centers.