Adverse ophthalmic reaction in poppers users: case series of 'poppers maculopathy'

Abstract

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.

Method: 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.

Discussion: 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.

Figure 1

Case 2: (a) January 2010 Fundus photography (OD and OS) showing discrete yellow lesions at both fovea. (b) October 2010 SD-OCT scan showing disruption of the IS/OS junction. (c) December 2011 SD-OCT scan showing increased disruption of the IS/OS junction after a further 14 months of continued poppers use.

Figure 2

Case 4 SD-OCT scan of the fovea (OD and OS). (a) Day 1 post inhalation of poppers and development of symptoms—retinal architecture appears normal. (b) 3 Months after inhalation of poppers—disruption of the IS/OS junction bilaterally. (c) 5 Months after inhalation of poppers—some improvement in symptoms and a reduction in the degree of IS/OS disturbance, OS more than OD. (d) 17th month, having resumed inhalation of poppers from month 6.