Figure Poppers maculopathy Show full caption (A) Colour fundus photography of the left eye showing subtle yellow foveal spots (arrow). (B) Left high-resolution spectral domain optical coherence tomography showing disrupted foveal photoreceptor inner segment–outer segment layer (arrow). A 30-year-old white man with no ocular history presented to eye casualty in Sidcup in October, 2012, with bilateral central visual loss, following inhalation of poppers. On examination his visual acuity was 6/12 on the right and 6/18 in the left eye. Slit lamp biomicroscopy showed subtle macular changes in the form of yellow foveal spots ( figure ). Spectral domain optical coherence tomography showed clear disruption of the foveal cone inner segment–outer segment layer ( figure ). At follow-up 6 months later, the patient's visual acuity and examination findings remained unchanged, despite cessation of poppers use.

Poppers (slang for various alkyl nitrite compounds) are commonly used in the gay community, for their ability to relax the anal sphincter and known psychoactive effects. Following changes to legislation in 2006, poppers' main ingredient, isobutyl nitrite, was substituted for isopropyl nitrite. Since then, there have been several reports of a new form of visual loss termed poppers maculopathy. The exact mechanism by which poppers cause damage to central photoreceptors is unknown, but there is a clear cause–effect relationship. Despite online warnings outlining the risks of poppers, the number of individuals presenting with associated visual loss is increasing. Fundoscopy findings can be very subtle, with more striking changes seen on optical coherence tomography. The relatively easy availability and widespread use of poppers is underestimated and concerning, given the propensity for permanent damage to the eyes. We would encourage both end-users and healthcare professionals to be aware of the potentially serious and irreversible damage poppers can have on vision.