A case of attempted bilateral self-enucleation in a patient with bipolar disorder

Abstract

Attempted and completed self-enucleation, or removal of one’s own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.

Self-enucleation of the right eye by a 38-year-old woman diagnosed with schizoaffective disorder: a case report

“…With an average of 1 in 30 million people, autoenucleation is a rare form of self-mutilation typically associated with psychiatric disorders such as schizophrenia, substance-induced psychosis and bipolar disorder [1][2][3]. It has also been seen, though more rarely, among patients with obsessive-compulsive disorder, depression as well as mental retardation, neurosyphilis, Lesch-Nyhan syndrome or structural brain lesions [3,4].…”

Subarachnoid hemorrhage and internal carotid artery dissection and occlusion following self-enucleation

“…Self-enucleation, also known as auto-enucleation or oedipism, is an uncommon type of self-mutilation that is classified as a major self-injury. [ 1 2 ] It is more common in men than in women[ 3 4 ] and is overwhelmingly associated with acute psychosis due to untreated psychiatric illnesses or drug use. [ 1 4 5 6 ] Self-enucleation involves avulsion of the extraocular muscles, optic nerve, and ophthalmic artery (OA), which may lead to devastating neurovascular complications.…”