Chronic poppers maculopathy: Case report and literature comparison of chronic and acute use

Rationale: – Alkyl nitrites (“poppers”) are recreational substances known for their vasodilatory and euphoric effects. Increasing evidence links them to a vision-threatening condition termed poppers maculopathy, characterized by foveal yellow spots and outer retinal changes on optical coherence tomography. While most reports describe acute exposure, little is known about long-term consequences. This case describes one of the longest documented durations of chronic poppers use, combined with a literature review to contextualize the clinical spectrum. Patient concerns: – A 68-year-old man with human immunodeficiency virus, type 2 diabetes, hypertension, and depression presented with progressive central vision loss in both eyes persisting for at least 5 years. Diagnoses: – Ophthalmologic examination revealed bilateral foveal yellow spots and retinal pigment epithelium changes. Optical coherence tomography showed photoreceptor and retinal pigment epithelium disruption in the foveal region, more severe in the right eye. Findings were consistent with poppers maculopathy. Interventions: – The patient was counseled regarding the suspected link between his chronic poppers use (≈30 years) and vision loss and advised to discontinue use. Outcomes: – The patient did not return for follow-up, and long-term outcomes remain unknown. Literature review (59 cases, 19 studies) indicated that chronic users present with more severe initial visual impairment compared with acute cases, although many showed partial recovery following cessation. Lessons: – This case underscores the importance of obtaining detailed drug use history in patients with unexplained foveal changes. Chronic exposure to poppers may cause cumulative retinal damage, leading to worse visual outcomes than acute use. Heightened clinical awareness and patient education are essential for the prevention and early recognition of this underdiagnosed condition.