Abstract
Purpose To review the pathogenesis, clinical characteristics, and management of self-inflicted eye injuries.
Methods Review of the medical literature.
Results Psychiatric theories of pathogenesis for self-inflicted behaviour include religious and sexual ideation, symbolism, guilt, and displacement. Biological theories include disorders of serotonergic, dopaminergic, and opiate neurotransmitters. Clinical characteristics of self-mutilators include acute or chronic psychoses, drug-induced psychoses, other psychiatric conditions, and certain organic states. The majority are young-to-early middle-aged male subjects, though it can also rarely occur in children. Management of self-inflicted eye injury requires close cooperation between ophthalmologists and psychiatrists as well as other medical specialists, to ensure quick resuscitation of the patient, prompt diagnosis and treatment of any injuries, and treatment of the underlying behaviour that led to the injuries.
Conclusions Self-inflicted eye injuries are a rare but important group of ophthalmic conditions that require close cooperation between different medical specialties to ensure optimum care of the often severely disturbed patient.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Favazza AR . The coming of age of self-mutilation. J Nerv Ment Dis 1998; 186(5): 259–268.
Yang HK, Brown GC, Magargal LE . Self-inflicted ocular mutilation. Am J Ophthalmol 1981; 91(5): 658–663.
Tapper CM, Bland RC, Danyluk L . Self-inflicted eye injuries and self-inflicted blindness. J Nerv Ment Dis 1979; 167(5): 311–314.
Stannard K, Leonard T, Holder G, Shilling J . Oedipism reviewed: a case of bilateral ocular self-mutilation. Br J Ophthalmol 1984; 68(4): 276–280.
Rogers T . Self-inflicted eye-injuries. Br J Psychiatry 1987; 151: 691–693.
Rosen DH, Hoffman AM . Focal suicide: self-enucleation by two young psychotic individuals. Am J Psychiatry 1972; 128(8): 1009–1012.
Bergua A, Sperling W, Kuchle M . Self-enucleation in drug-related psychosis. Ophthalmologica 2002; 216(4): 269–271.
Oren DA, Laor N . Self-inflicted eye injury. Am J Psychiatry 1987; 144(2): 248–249.
Stinnett JL, Hollender MH . Compulsive self-mutilation. J Nerv Ment Dis 1970; 150(5): 371–375.
Khan JA, Buescher L, Ide CH, Pettigrove B . Medical management of self-enucleation. Arch Ophthalmol 1985; 103(3): 386–389.
Kennedy BL, Feldmann TB . Self-inflicted eye injuries: case presentations and a literature review. Hosp Community Psychiatry 1994; 45(5): 470–474.
Ashkenazi I, Shahar E, Brand N, Barton E, Blumenthal M . Self-inflicted ocular mutilation in the pediatric age group. Acta Paediatr 1992; 81(8): 649–651.
Winchel RM, Stanley M . Self-injurious behavior: a review of the behavior and biology of self-mutilation. Am J Psychiatry 1991; 148(3): 306–317.
Waldfogel S, Field HL, Wu L . Oedipism in a patient with frontal lobe encephalomalacia. Brain Injury 1994; 8(4): 377–381.
MacLean G, Robertson BM . Self-enucleation and psychosis. Report of two cases and discussion. Arch Gen Psychiatry 1976; 33(2): 242–249.
Grapplin P . Germanic lands: the mortal gods. In: Grimal P (ed). Larousse World Mythology. Hamlyn Publishing: London, 1965.
Davison HRE . Gods and Myths of Northern Europe. Penguin: New York, 1964.
Duke-Elder S . Systems of Ophthalmology, Vol 7. Kimpton: London, 1962, pp 470–471.
Favazza AR, Rosenthal RJ . Diagnostic issues in self-mutilation. Hosp Community Psychiatry 1993; 44(2): 134–140.
Eisenhauer GL . Self-inflicted ocular removal by two psychiatric inpatients. Hosp Community Psychiatry 1985; 36(2): 189–191.
Shore D, Anderson DJ, Cutler NR . Prediction of self-mutilation in hospitalized schizophrenics. Am J Psychiatry 1978; 135(11): 1406–1407.
Aksaray G, Erol S, Kaptanoglu C . Self-inflicted bilateral eye injury by a schizophrenic patient. Gen Hosp Psychiatry 2000; 22(3): 215–216.
Ananth J, Kaplan HS, Lin KM . Self-inflicted enucleation of an eye: two case reports. Can J Psychiatry 1984; 29(2): 145–146.
Crowder JE, Gross CA, Heiser JF, Crowder AM . Self-mutilation of the eye. J Clin Psychiatry 1979; 40(10): 420–423.
Robertson MM, Trimble MR, Lees AJ . Self-injurious behaviour and the Gilles de la Tourette syndrome: a clinical study and review of the literature. Psychol Med 1989; 19(3): 611–625.
Apter A, van Praag HM, Plutchik R, Sevy S, Korn M, Brown SL . Interrelationships among anxiety, aggression, impulsivity, and mood: a serotonergically linked cluster? Psychiatry Res 1990; 32(2): 191–199.
Garcia-Estrada A . Self-inflicted eye injuries. Br J Psychiatry 1988; 153: 266.
Shiwach RS . Autoenucleation—a culture-specific phenomenon: a case series and review. Compr Psychiatry 1998; 39(5): 318–322.
Moskovitz RA, Byrd T . Rescuing the angel within: PCP-related self-enucleation. Psychosomatics 1983; 24(4): 402–403, 40, 6.
Leslie J, Taff ML, Patel I, Sternberg A, Fernando MM . Self-inflicted ocular injuries. A rare form of self-mutilation. Am J Forensic Med Pathol 1984; 5(1): 83–88.
Voutilainen R, Tuppurainen K . Ocular Munchhausen syndrome induced by incest. Acta Ophthalmol (Copenh) 1989; 67(3): 319–321.
Rosenberg PN, Krohel GB, Webb RM, Hepler RS . Ocular Munchausen's syndrome. Ophthalmology 1986; 93(8): 1120–1123.
Winans JM, House LR, Robinson HE . Self-induced orbital emphysema as a presenting sign of Munchausen's syndrome. Laryngoscope 1983; 93(9): 1209–1211.
Goldsmith W . Self-enucleation: further views. Am J Psychiatry 1973; 130(3): 329.
Soebo J . Automutilatio bulborum. A rare case of self-mutilation in an epileptic. Acta Ophthalmologica 1948; 26: 451–453.
Goodhart SP, Savitsky N . Self-mutilation in chronic encephalitis. Avulsion of both eyeballs and extraction of teeth. Am J Med Sci 1933; 185: 674–684.
Brown BZ . Self-inflicted injuries of the eye. Ann Ophthalmol 1972; 4(2): 147–149, (passim).
Niiranen M, Raivio I . Eye injuries in children. Br J Ophthalmol 1981; 65(6): 436–438.
Noel LP, Clarke WN . Self-inflicted ocular injuries in children. Am J Ophthalmol 1982; 94(5): 630–633.
Van Woert MH, Yip LC, Balis ME . Purine phosphoribosyltransferase in gilles de la Tourette syndrome. N Engl J Med 1977; 296(4): 210–212.
Axenfeld T . Uber Luxation, Zerstorung und Herausreissung des Augapfels als Selbstverstummelung bei Geisteskranken. Z Augenheilkd 1899; 1: 128.
Field HL, Waldfogel S . Severe ocular self-injury. Gen Hosp Psychiatry 1995; 17(3): 224–227.
Jones NP . Self-enucleation and psychosis. Br J Ophthalmol 1990; 74(9): 571–573.
Krauss HR, Yee RD, Foos RY . Autoenucleation. Surv Ophthalmol 1984; 29(3): 179–187.
Yucel B, Ozkan S . A rare case of self-mutilation: self-enucleation of both eyes. Gen Hosp Psychiatry 1995; 17(4): 310–311.
Distler JA, Utrata PJ, File MP . Traumatic enucleation: a clinicopathologic case report. Ann Ophthalmol 1981; 13(10): 1169–1170.
Nettleship E . Intracranial affections: on a case of meningitis after excision of the eye ball. Trans Ophthalmol Soc UK 1886; 6: 445–480.
Lasky JB, Epley KD, Karesh JW . Household objects as a cause of self-inflicted orbital apex syndrome. J Trauma 1997; 42(3): 555–558.
Bowen DI . Self-inflicted orbitocranial injury with a plastic ballpoint pen. Br J Ophthalmol 1971; 55(6): 427–430.
Albert DM, Burns WP, Scheie HG . Severe orbitocranial foreign-body injury. Am J Ophthalmol 1965; 60(6): 1109–1111.
Lunetta P, Ohberg A, Sajantila A . Suicide by intracerebellar ballpoint pen. Am J Forensic Med Pathol 2002; 23(4): 334–337.
Shuttleworth GN, Galloway PH . Ocular air-gun injury: 19 cases. J Roy Soc Med 2001; 94(8): 396–399.
Kirkby GR . Penetrating orbitocranial injury with a snooker cue. Br Med J (Clin Res Ed) 1986; 293(6562): 1646.
Sharif S, Roberts G, Phillips J . Transnasal penetrating brain injury with a ball-pen. Br J Neurosurg 2000; 14(2): 159–160.
Palmowski A, Heinz G, Ruprecht KW . Self-inflicted injuries of the eye: differential diagnosis of self-inflicted lacerating corneal injury. Klin Monatsbl Augenheilkd 1994; 204(1): 30–32.
Chern KC, Meisler DM, Wilhelmus KR, Jones DB, Stern GA, Lowder CY . Corneal anesthetic abuse and Candida keratitis. Ophthalmology 1996; 103(1): 37–40.
Brown R, al-Bachari MA, Kambhampati KK . Self-inflicted eye injuries. Br J Ophthalmol 1991; 75(8): 496–498.
Zamir E, Read RW, Rao NA . Self-inflicted anterior scleritis. Ophthalmology 2001; 108(1): 192–195.
Mawn LA, Jordan DR . Trichotillomania. Ophthalmology 1997; 104(12): 2175–2178.
Smith JR . Trichotillomania: ophthalmic presentation. Aust NZ J Ophthalmol 1995; 23(1): 59–61.
Jornod P, Vannotti M, Dascal DR, Auer C, Berode M, Savolainen H . Voluntary mercury poisoning: biological consequences and psychiatric significance. Schweiz Rundsch Med Prax 1997; 86(22): 946–951.
Blackmon DM, Calvert HM, Henry PM, Westfall CT . Bacillus cereus endophthalmitis secondary to self-inflicted periocular injection. Arch Ophthalmol 2000; 118(11): 1585–1586.
Favazza AR . Literature on sun gazing. Am J Psychiatry 1991; 148(2): 281–282.
Anaclerio AM, Wicker HS . Self-induced solar retinopathy by patients in a psychiatric hospital. Am J Ophthalmol 1970; 69(5): 731–736.
Eigner EH . Self-induced solar retinitis. Am J Ophthalmol 1966; 61(6): 1546–1547.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patton, N. Self-inflicted eye injuries: a review. Eye 18, 867–872 (2004). https://doi.org/10.1038/sj.eye.6701365
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6701365
Keywords
This article is cited by
-
Postpartale Keratopathie
Der Ophthalmologe (2022)
-
Self-enucleation of the right eye by a 38-year-old woman diagnosed with schizoaffective disorder: a case report
BMC Psychiatry (2020)
-
Retinal burns from laser pointers: a risk in children with behavioural problems
Eye (2019)
-
“The pen is mightier than the sword” – suicidal trans-orbital intracranial penetrating injury from a pencil
Forensic Science, Medicine and Pathology (2018)
-
Self-induced Elizabethkingia meningoseptica endophthalmitis: a case report
Journal of Medical Case Reports (2011)
