Purpose:
To recognize risk factors for and potential life-threatening complications of autoenucleation.
Methods:
A review of the literature and two cases from the University of Iowa Oculoplastics service.
Results:
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).
Conclusions:
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.
Keywords: trauma • orbit • neuro-ophthalmology: optic nerve