Citation

Clinebell K, Valpey R, Walker T, Gopalan P, Azzam P. Psychosomatics 2016; 57(1): 25-30.

Affiliation

Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA.

Copyright

(Copyright © 2016, Academy of Psychosomatic Medicine, Publisher Elsevier Publishing)

DOI

10.1016/j.psym.2015.10.010

PMID

26791513

Abstract

BACKGROUND: Although the first medically-reported case of auto-enucleation was described in the mid-19th century, ocular self-gouging has long been depicted in historical legend and mythology. Cases of enucleation have since been identified across various cultures. Though relatively uncommon, this major form of self-mutilation now afflicts approximately 500 individuals per year, and may present more commonly among certain clinical populations.

METHODS: We present 2 cases of self-enucleation in patients with psychotic illnesses and review existing literature on the history of enucleation, associated pathology, and management (both medically and psychiatrically) for this serious form of self-injury.

RESULTS: Literature review includes a brief historical perspective of auto-enucleation and its context in psychosomatic medicine, with cases to highlight key aspects in the prevention and management of ocular self-injury. Normal eye pathology is described briefly, with a focus on medical care after self-inflicted damage, as pertinent to consultation psychiatrists. Interventions for behavioral and pharmacologic management of agitation and impulsivity are reviewed, including consideration for electroconvulsive therapy, in this particular context.

CONCLUSION: Although severe ocular self-injury is uncommon, psychiatrists should be familiar with approaches to prevent and manage auto-enucleation in individuals at risk thereof. Consultation psychiatrists must work closely with ophthalmologists to address affective, behavioral, and cognitive triggers and complications of ocular self-injury.

Language: en