Complications and outcomes after autoenucleation

Gauger, Elizabeth H.; Allen, Richard C.

doi:10.1097/icu.0000000000000184

Cited by 11 publications

(30 citation statements)

References 37 publications

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“…For it is better that you lose one of your members than that your whole body be thrown into hell." Mathew 5:29 The act recommended in the Bible verse above is selfenucleation, also known as autoenucleation, which is a self-inflicted, complete removal of one's eye [1].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Autoenucleation is a rare form of self-mutilation typically associated with psychiatric disorders such as schizophrenia, substance-induced psychosis and bipolar disorder. The act is usually unilateral, although bilateral attempts are also well documented in the literature. Case presentation It is a case study involving a female patient (NN) diagnosed with schizoaffective disorder who self-enucleated her right eye following sexual intercourse with a fellow patient, and was forcefully prevented by staff from enucleating the second eye. We report recurrent episodes of her illness culminating in this severe act of self-mutilation. The motivational reasons behind this form of self-harm along with differential diagnosis and potential treatment options are discussed in the context of the available literature. Conclusion Autoenucleation is commonly associated with religious and sexual delusions, and patients are thought to be at a greater risk of further self-harm. Timely antipsychotic treatment is likely to reduce the risk of such extreme forms of self-harm, although they can occur despite robust therapeutic intervention and treatment attempts. While self-inflicted eye injuries are rare, their prevention in what is typically a difficult patient group is fraught with challenges.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Self-enucleation is an uncommon type of major self-injury, which may lead to severe neurological deficits and life-threatening complications, such as subarachnoid hemorrhage (SAH) and internal carotid artery (ICA) dissection and occlusion. Our patient is a 53-year-old man with a history of bipolar disorder and schizophrenia who presented with SAH, intraventricular hemorrhage, ICA dissection and occlusion, and right cerebral infarct following self-enucleation. Despite a Glasgow Coma Score of 6 on initial presentation, he improved with conservative management. He achieved a near-complete neurological recovery, with residual left lower extremity weakness and mild confusion. Self-enucleation is a major neurologic, ophthalmologic, and psychiatric emergency with a potential for serious neurological complications and contralateral visual loss. Yet, conservative management may lead to dramatic recovery.

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“…2 A review of 56 cases found that one third of the cases are bilateral. 3 The most common underlying motivations for selfenucleation are biblical interpretation, hypersexual or hyperreligious delusions, and paranoia regarding the eye.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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Complications and outcomes after autoenucleation

Abstract: Autoenucleation occurs more frequently in patients with psychiatric illness or drug abuse. It can be a devastating injury, not only locally, but neurologically. Ophthalmologists should be aware of the potentially life-threatening consequences of autoenucleation.

Cited by 11 publications

References 37 publications

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

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

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

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

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