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Shuchi Agarwal, Aaron Savar, Todd R. Shepler, Edward J. Wladis, Robert Schwarcz, Roman Shinder; Nonsurgical Enucleation: Presentation & Surgical Strategies. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1066.
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Auto-enucleation is a severe form of self-inflicted eye injury. Past reports describe this typically in schizophrenic or drug abusing patients. We report the presentation, radiography, & treatment outcomes in 2 patients with nonsurgical enucleation, and 1 patient who failed attempted auto-enucleation.
Records of 3 patients evaluated for nonsurgical enucleation were reviewed.
2 cases involved self-mutilation in male schizophrenic patients (Fig 1); another a female in a car accident (Fig 2). Median age was 24 years. The diagnosis in all cases was confirmed by exam of the orbit, enucleated globe, and CT. Surgery included: orbital implant placement in a man who enucleated himself; ruptured globe repair in a schizophrenic man who failed attempted auto-enucleation; & fracture repair with orbital reconstruction in a girl injured in a car accident. At last follow up the man treated with the orbital implant wore a conformer and did well; the man with the ruptured globe had a vision of 20/100 with an altitudinal field defect from optic neuropathy; and the girl involved in the car accident had acceptable periocular reconstruction but suffered from depression.
Self-enucleation is a rare phenomenon seen in patients with psychiatric or intracranial disease. Psychotic patients often incur auditory hallucinations that cite the eye as "evil". Although auto-enucleation is uncommon, its clinical implications are dramatic. Cases may be accompanied by significant bleeding secondary to damage of the ophthalmic artery, often manifested as orbital or subarachnoid hemorrhage. Management involves assessment of neurologic and mental status, orbital reconstruction following CT imaging, & prevention of future injury. Also, the contralateral eye must be followed closely in these patients to assess for possible sympathetic ophthalmia.
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