Experimenting with "poppers" -- inhaled alkyl nitrates used as recreational drugs -- can cause lasting retinal damage, ophthalmologists warned.
Four cases over a three-month period in France were reported in a letter to the editors appearing in the Oct. 14 issue of the New England Journal of Medicine.
The prolonged visual loss likely resulted from damage to foveal photoreceptors by the acute, massive release of nitric oxide from the drugs, Michel Paques, MD, PhD, of the Quinze-Vingts Hospital in Paris, and colleagues wrote.
Poppers' popularity at parties and clubs for the intoxication and enhancement of sexual pleasure they produce has gone unopposed by law enforcement, the French group noted. These compounds are found in products such as air freshener and video head cleaner as well as brands made specifically for recreational inhalation.
Despite the drugs' relatively innocuous reputation, the American Academy of Ophthalmology (AAO) urged the public to avoid their use based on these results.
No conclusive studies prove the short- or long-term effects of poppers, but avoidance is a sure way to prevent possible harm, the AAO noted in a statement sent to reporters.
Only two case reports of visual loss after inhalation of poppers have appeared in the literature over the past 10 years, but Internet forums suggest visual problems are not so rare as they might seem, according to Paques' group.
Their first case occurred early this year in a 27-year-old woman who saw a "bright central dot" and otherwise reduced vision in both eyes that started 11 days earlier, when she inhaled Jungle Juice-brand poppers at a party, along with about half a bottle of strong alcohol.
Her symptoms appeared to be due to a yellow foveal dot in both eyes that high-resolution optical coherence tomography indicated was due to damage to the photoreceptor outer segment in the fovea.
The symptoms and findings persisted without change one month later.
A second patient who had inhaled poppers with the first woman at the party was also seen, along with two other patients, within a three-month period; like the first patient, all three of these patients showed visual loss with bright spots in the center of their vision after inhaling isopropyl nitrite. Symptoms resolved for two of these three patients over several weeks.
The reason for the "outbreak" might have been due to increased availability of poppers in the population or introduction of more powerful brands, Paques and colleagues suggested.
The effects likely stem from nitric oxide's role in photoreceptor metabolism and function as well as its potent vasodilator activity, in which acute changes in ocular perfusion pressure might have added to the retinal damage, they explained.
Disclosures
The article was supported by the Institut National de la Santé et de la Recherche Médicale, the Direction de l'Hospitalisation et des Soins, and the Foundation Fighting Blindness.
The authors reported having no conflicts of interest to disclose.
Primary Source
New England Journal of Medicine
Vignal-Clermont C, et al "Poppers-associated retinal toxicity" N Engl J Med 2010; 363: 1583-1584.