. 2021; 51(1): 58-61

Multiple penetrating eye wounds due to suspected self-injury

José Dalma Weiszhausz1, José Arturo Oyervides Alvarado1, Ana Maria Suarez Licona1, Miriam Serment2, Alexander Dalma3
1Asociación para Evitar la Ceguera en México, Ciudad de México, México
2Instituto Nacional de Psiquiatría Ramón de la Fuente, Ciudad de México, México
3Dalma & Asociados, SC. Cuidad de México, México

We present a case of a 29 year-old male night watchman complaining of sudden decreased vision, redness and tearing of the left eye. On anamnesis, trauma was denied and personal past history was relevant for right eye enucleation due to an “eye injury” eight years prior. At presentation visual acuity was 20/200, intraocular pressure (IOP) of 10mmHg. Slit lamp examination revealed a 1mm inferonasal corneal wound and a localized lens opacity associated with extrusion and posterior extension of cortical material in the same quadrant. Echography confirmed posterior lens capsular bag puncture with hyperechogenic material in the anterior vitreous. Intraocular foreign body was ruled out. Topical anti-inflammatory and cycloplegic treatment was initiated with partial visual recovery, intraocular pressure rise, moderate anterior chamber inflammatory reaction and an emergent posterior subcapsular cataract. A pars plana vitrectomy and lensectomy were performed. After surgery and recovery, best-corrected visual acuity with contact lens achieved 20/15. Patient was followed for six years, on which he returned six more times with a variety of new findings, such as new corneal leukoma, leaking corneal wounds, hypotony, choroidal folds and choroidal detachments, every time with full visual acuity recovery.

Some cases of ocular injury and self-mutilation have been described in the context of psychiatric disorders including psychotic symptoms obsessive-compulsive spectrum, corporal dysmorphic, affective disorders post-traumatic stress, factitious disorder, borderline personality and substance abuse. Self-inflicted injuries were suspected due to substance abuse even though the patient denied the probable self-induced nature of the wounds. Referral to a psychiatrist was insisted in several occasions without success.

Patients that present with self-enucleation are related to psychiatric diseases mainly in the schizophrenic spectrum. Complications that can be life-threatening may arise, therefore psychiatric referral is mandatory.

Keywords: Self-injurious behavior, self-mutilation, substance abuse, psychotic symptoms, self injury, Oedipism


José Dalma Weiszhausz, José Arturo Oyervides Alvarado, Ana Maria Suarez Licona, Miriam Serment, Alexander Dalma. Multiple penetrating eye wounds due to suspected self-injury. . 2021; 51(1): 58-61

Corresponding Author: José Dalma Weiszhausz, Mexico


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