Popper associated maculopathy – case report and literary synthesis

Purpose Prevalence of Alkyl Nitrate, or ‘Poppers’ abuse has remained high since its putative birth in the urban disco scene of the 1970's, with UK figures from 2014 suggesting a 9.1% adult lifetime use rate. However, an associated retinal toxicity is a new and emerging phenomenon due to the recent change of its main compound and continued popular recreational use. Here, we describe a case of Alkyl Nitrate associated maculopathy. Methods Case report with literary synthesis. Results A 44‐year‐old Caucasian male with no previous ophthalmic history presented to our eye casualty department with bilateral central vision blurring following repeated inhalation of Alkyl nitrates. Drug use was believed to have occurred twice daily by inhalation over an interrupted 6‐week period. Best‐corrected visual acuity at presentation was 6/6‐1 in the right eye and 6/9+1 in the left. Fundal photography reveals subtle yellow foveal spots bilaterally with an otherwise normal peripheral retina and optic disc. Optical coherence topography demonstrates marked disruption of the photoreceptor inner segment / outer segment junction. Fundus Fluorescein Angiography exhibits a subtle foveal hyper‐fluorescence bilaterally. Multifocal ERG displayed attenuated responses from the foveal and parafoveal segments of the left eye with blunting of the foveal peak. A synthesis of current literature and various hypotheses to date is subsequently discussed. Conclusions The rarity of this phenomenon, along with tendencies of reluctant disclosure of substance abuse behaviours, can lead to diagnostic difficulties. When faced with bilateral painless central blurring, in otherwise healthy, young individuals, physicians should obtain a detailed history of possible substance abuse.