Popper Maculopathy

Overview

“Poppers” are recreational drugs and their use has been associated with bilateral maculopathy, scotomas and photophobia. This condition can be difficult to distinguish from solar retinopathy with patient history an important distinguishing factor.

Clinically, bilateral yellow dots may be seen at the fovea. This corresponds to changes in the outer retinal layers on OCT which may be either hyper-reflectivity of the ellipsoid zone or a subfoveal hypo-reflectivity. Fundus autofluorescence is typically normal.

Case Examples

  • Case 1: Presumed Popper Maculopathy

    A 56 year old Middle Eastern male with a long history of drug use and reduced vision. He denies any history of sun gazing or watching eclipses.

    Fundus photo and red-free image (right eye)

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    Fundus photo and red-free image (right eye)

    Fundus photos show a central round lesion with mild depigmentation and drusenoid changes superior to the fovea (unrelated to the popper maculopathy).

    Fundus photo and red-free image (right eye)

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    Fundus photo and red-free image (right eye)

    Fundus photos show a central round lesion with mild depigmentation and drusenoid changes infero-temporal to the macula (unrelated to the popper maculopathy).

    Cirrus OCT line scan (right macula)

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    Cirrus OCT line scan (right macula)

    OCT imaging shows a typical foveal pit contour with an underlying rectangular-shaped outer retinal 'hole' extending from the inner border of the RPE to the external limiting membrane.

    This pattern is commonly associated with a history of volatile alkyl nitrite abuse ("popper maculopathy") or history of sun- gazing (solar retinopathy). In this case the patient history was used to determine the working diagnosis.

    The macular OCT findings correlate structurally with the reduction in the patient's best corrected visual acuity.

Differential Diagnosis

Solar Retinopathy

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Macular Microhole

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Macular Telangiectasia 2

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References

Hui, M. Galvin, J. Chilov, M. Gabrielle, PH. Fung, A. et al. (2020). Popper Maculopathy: Long Term Follow-up and Case Series. Retinal Cases & Brief Reports, 14, 195-199.