On further history the patient denied sungazing or exposure to lasers, however, did report using poppers (alkyl nitrites) recreationally for the first time the week prior to presentation. A presumptive diagnosis of popper maculopathy was made.

Popper maculopathy is a toxic foveal disorder caused by inhaled alkyl nitrites, presenting with bilateral blurred central vision, scotomas, metamorphopsia or photopsias, often with subtle yellow foveal lesions and disruption of the photoreceptor ellipsoid zone on OCT; recognised patterns include focal ellipsoid-zone disturbance, vitelliform-like lesions and microholes. The mechanism remains uncertain, but alkyl nitrites are thought to raise retinal nitric oxide levels causing free-radical oxidative injury to foveal photoreceptors, possibly with increased susceptibility to light damage. Stopping poppers is advised, although visual and anatomical recovery varies and chronic exposure may cause persistent damage.