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.

Fatal Oedipism: A Case Report and Literature Review

“…Our review of the literature included 54 articles and 75 patients who self-enucleated at least one eye. 1,3–55 The features of these patients are described in Table 1. The patients had an average age of 37 years (±14 SD) and were 50.7% male.…”

A Case of Self‐Enucleation in an Incarcerated Patient: Case Report and Review of Literature

“…Drugs implicated in cases of self-enucleation include cannabis, hallucinogens like lysergic acid diethylamide and phencyclidine, and stimulants including amphetamine and cocaine (19)(20)(21)(22). In addition to psychosis, severe obsessive-compulsive disorder (23), mood disorders with psychotic features (13,(24)(25)(26), factitious disorder and malingering (27) and severe character pathology (28) have also been implicated as an underlying cause for this form of self-injurious behavior. Interestingly, there have also been reports of auto-enucleation in organic illnesses like neurosyphilis (29), Lesch-Nyhan syndrome (29,30) Down syndrome (31), structural brain lesions (32), and postictal psychosis (33) In this case, religious delusions, as command auditory hallucinations "from Satan," demanded the enucleation.…”

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.…”