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Elizabeth H. Gauger, Rachel K. Sobel, Richard C. Allen; Complications and Outcomes After Autoenucleation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1466.
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To recognize risk factors for and potential life-threatening complications of autoenucleation.
A review of the literature and two cases from the University of Iowa Oculoplastics service.
Two adult Caucasian males were transferred from outside hospitals after autoenucleation. One patient had a urine toxin screen positive for methamphetamines. The second patient had a history of uncontrolled schizophrenia and had recently self-discontinued his psychiatric medications. In both cases, imaging of the head and orbits was done to rule-out secondary sequelae after self-enculeation. Patient 1 did not have any intracranial abnormalities and had an overall uncomplicated course (Image 1). Patient 2 had a head CT that showed a left internal carotid artery dissection, subarachnoid hemorrhage, and basal ganglia and thalamic stroke. The left internal carotid artery dissection was confirmed by magnetic resonance angiography (Image 2).
Autoenucleation occurs more frequently in patients with psychiatric illness or drug abuse, according to the literature. It can be a devastating injury, not only locally, but neurologically. Ophthalmologists, as well as ER physicians and psychiatrists should be aware of the potentially life-threatening consequences of autoenucleation. We believe this is the first reported case of internal carotid dissection after autoenucleation, which highlights the need for prompt attention and head imaging.
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