Adverse ophthalmic reaction in poppers users: case series of 'poppers maculopathy'.
BACKGROUND
Poppers are a recreational substance of abuse belonging to the alkyl nitrite family of compounds. In the United Kingdom, where they are legal to purchase but illegal to sell for human consumption, 10% of the general population have tried them. They are considered low risk to physical and mental health. Two recent case series from France demonstrated foveal pathology in individuals associated with poppers use.


METHODS
A case series of seven patients presenting to four hospitals in the United Kingdom with visual impairment and maculopathy associated with inhalation of poppers.


RESULTS
All patients experienced visual symptoms associated with poppers use. The majority had impaired visual acuity, central scotomata, distortion, or phosphenes. Clinical signs on fundoscopy ranged from normal foveal appearance to yellow, dome-shaped lesions at the foveola. Spectral domain optical coherence tomography (SD-OCT) showed varying degrees of disruption of the presumed inner segment/outer segment (IS/OS) junction.


CONCLUSIONS
Although poppers have been in use for several decades, in 2007, following legislative changes, there was a change in the most commonly used compound from isobutyl nitrite to isopropyl nitrite. There were no reports of 'poppers maculopathy' before this. Poppers maculopathy may be missed if patients are not directly questioned about their use. The disruption or loss of the presumed IS/OS junction on SD-OCT are a characteristic feature. Further study of maculopathy in poppers users is now needed. Raising public awareness of the ocular risks associated with their use may be necessary.
Department of Ophthalmology, Royal Bolton Hospital, Bolton, UK.
A J
AJ
Davies
S P
SP
Kelly
S G
SG
Naylor
P R
PR
Bhatt
J P
JP
Mathews
J
J
Sahni
R
R
Haslett
M
M
McKibbin
D000280:Administration, Inhalation; D000328:Adult; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D009573:Nitrites / Q000009:adverse effects; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D055211:Retinal Photoreceptor Cell Inner Segment / Q000187:drug effects* / Q000473:pathology; D055214:Retinal Photoreceptor Cell Outer Segment / Q000187:drug effects* / Q000473:pathology; D041623:Tomography, Optical Coherence; D014665:Vasodilator Agents / Q000009:adverse effects*; D014786:Vision Disorders / Q000139:chemically induced* / Q000175:diagnosis; D014792:Visual Acuity / Q000187:drug effects
D013287:Illicit Drugs; D009573:Nitrites; D014665:Vasodilator Agents; C018086:isobutyl nitrite