A Case of Self‐Enucleation in an Incarcerated Patient: Case Report and Review of Literature

Abstract

Self-enucleation is a severe form of self-injurious behavior which presents as an ophthalmologic and psychiatric emergency. It is usually known to occur with untreated psychosis, however, there have been reports of self-enucleation across various psychopathologies. We review a case documenting self-enucleation in the forensic setting in a patient with an unusual presentation and cluster of psychotic symptoms. Literature was reviewed using PubMed/Medline databases with key terms: "forensic science," "forensic psychiatry," "auto-enucleation," "self-enucleation," "Oedipism," "self-harm." This case is unique as it offers an alternative presentation to those most commonly depicted in current literature, helps highlight the sparsity of literature depicting self-enucleation in the forensic setting, and stimulates discussion around various potential differential diagnoses, management strategies and complications of self-enucleation within the forensic setting. It is prudent to emphasize need for aggressive and collaborative treatment for the forensic population regardless of psychopathology, presentation, or propensity for secondary gain.

Self-inflicted bilateral ocular and eyelid injuries in an unsuspected individual

“…3 Other psychiatric associations include depression, borderline personality disorder, post-traumatic stress disorder and obsessive compulsive disorder. 3,4 They can also be associated with some organic disorders such as neurosyphilis, epilepsy, Lesch-Nyhan Syndrome, dementia, structural brain lesions and even diabetes. [3][4][5] Drugs have been implicated in some cases, including cannabis, stimulants such as amphetamine and cocaine, and hallucinogens.…”

“…3,4 They can also be associated with some organic disorders such as neurosyphilis, epilepsy, Lesch-Nyhan Syndrome, dementia, structural brain lesions and even diabetes. [3][4][5] Drugs have been implicated in some cases, including cannabis, stimulants such as amphetamine and cocaine, and hallucinogens. 4 One study which reviewed 41 cases found that the majority of cases involved young, male schizophrenics, psychotics or those suffering from alcohol or drug abuse.…”

“…[3][4][5] Drugs have been implicated in some cases, including cannabis, stimulants such as amphetamine and cocaine, and hallucinogens. 4 One study which reviewed 41 cases found that the majority of cases involved young, male schizophrenics, psychotics or those suffering from alcohol or drug abuse. 6 Self-inflicted ocular injuries can range from mild anterior segment trauma such as trichotillomania to penetrating orbital injuries, lid lacerations and even enucleation.…”

“…Self-enucleation is the most severe form, also known as oedipism, in reference to the Greek legend of Oedipus, who gouged his eyes out. 3,4 Modes of injury include blunt trauma, digital injuries and use of common household objects. 4 The true incidence of self-inflicted ocular injuries may be difficult to quote, as the literature is sparse and predominantly limited to case reports/series.…”

“…3,4 Modes of injury include blunt trauma, digital injuries and use of common household objects. 4 The true incidence of self-inflicted ocular injuries may be difficult to quote, as the literature is sparse and predominantly limited to case reports/series. A recent literature review suggested a higher predilection in men, with a ratio of 8:1, and in Caucasians.…”