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.
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Acknowledgements
We are grateful to Stuart Wilson, Community Optometrist, for clinical data and referral. We are grateful to Mr Peter Bogaert and Dr Peter Feldschreiber for legal comments. We are grateful to Dr John Ramsey, director of TICTAC, for advice.2
Ethical matters
Patient consent for publication was obtained.
Author contributions
AJD, SPK, and SGN are responsible for drafting this manuscript. AJD, SPK, PRB, and MMcK are responsible for conceiving this contribution. PRB, SPK, AJD, SGN, JS, JM, RH, and MMcK were involved in patient care. SPK and AJD are guarantors of this article.
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The authors declare no conflicts of interest relevant to this subject matter.
Additional information
Some of this material was presented at the Yorkshire Retina Society meeting in 2011 and North of England Ophthalmic Society in March 2012.
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Davies, A., Kelly, S., Naylor, S. et al. Adverse ophthalmic reaction in poppers users: case series of ‘poppers maculopathy’. Eye 26, 1479–1486 (2012). https://doi.org/10.1038/eye.2012.191
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DOI: https://doi.org/10.1038/eye.2012.191
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