Background: Chloroquine is an antimalarial drug, while hydroxychloroquine is an analogue of chloroquine. Hydroxychloroquine (HCQ) is used to treat autoimmune diseases in addition to malaria. They have toxic effects on retina. Different screening protocols were described to detect HCQ toxicity. Objective: The aim of the current work was to study the ability of optical coherence tomography angiography (OCTA) to detect early retinal changes that may occur after HCQ treatment in patients with rheumatoid arthritis. Patient and Methods: This prospective cross-sectional study included a total of 40 eyes of 20 patients who were newly or previously prescribed HCQ for rheumatoid arthritis, recruiting from the Department of Ophthalmology, Al-Zahraa University Hospital. This study was conducted between May 2018 to Dec 2019. OCTA imaging was performed via Angiovue software. Results: The superficial whole vascular density, superficial parafoveal vascular density, superficial perifoveal vascular density, deep whole vascular density, deep parafoveal vascular density, and deep perifoveal vascular density were thinner in treatment groups compared to the control group (p < 0.05). Conclusion: OCTA could be a beneficial tool for screening of HCQ retinal affection. It could detect the decrease in the deep capillary plexus at the parafoveal and perifoveal regions in patients who were receiving HCQ treatment.