Purpose To describe a case of transient, partial, central retinal artery occlusion with paracentral acute middle maculopathy optical coherence tomography presentation in a young healthy patient after ingestion of the synephrine-containing supplement, Havok. Methods Retrospective case report with fundus photography, fluorescein angiography, and optical coherence tomography. Results A 20-year-old man presented with severe acute vision loss in the right eye. Dilated examination demonstrated cherry red spot with surrounding edema in the macula. Optical coherence tomography showed hyperreflectivity in the middle retinal layer of the macula consistent with paracentral acute middle maculopathy. Fluorescein angiography showed delayed arteriovenous transit time consistent with a central retinal artery occlusion. Bloodwork to investigate a hypercoagulable state and vasculitis were negative. At 1-week follow-up, dilated examination demonstrated resolution of the cherry red spot. At 3 months, the patient's visual acuity was back to normal. Fluorescein angiography showed complete resolution of the retinal artery occlusion, but optical coherence tomography of the macula demonstrated mild, residual middle retina thinning consistent with chronic presentation of paracentral acute middle maculopathy. Conclusion Because of synephrine's physiological and structural similarity to the vasoconstrictive compound ephedra, it is reasonable to suggest that there is potential health hazard in this performance-enhancing compound.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
