Castro Hannah Muniz, Alvarez John, Bota Robert G, Yonkers Marc, Tao Jeremiah
School of Medicine, University of California, Irvine, CA.
Department of Psychiatry, University of California, Irvine, CA.
Ment Illn. 2017 Jun 26;9(1):7141. doi: 10.4081/mi.2017.7141. eCollection 2017 Mar 22.
Attempted and completed self-enucleation, or removal of one's own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.
试图或完成自我眼球摘除，即摘除自己的眼睛，是一种罕见但极具破坏性的自残行为形式。它通常与精神疾病相关，尤其是精神分裂症、物质所致精神病和双相情感障碍。我们报告一例有双相情感障碍病史的患者，他双侧挖眼试图自我摘除眼球。就诊时，患者处于躁狂发作状态，伴有宗教妄想的精神病性特征以及上帝命令他摘除眼睛的命令性幻听。就诊时，患者双眼无光感，检查显示严重眼球突出、广泛的结膜裂伤以及右侧眼外肌明显撕脱。眼眶紧急计算机断层扫描显示眼球小且不规则、眼眶内有气体以及眼内出血。他被送往手术室进行损伤的手术修复。试图和完成自我眼球摘除最常与精神分裂症和物质所致精神病相关，但也可出现在双相情感障碍患者中。其他较少相关的疾病包括强迫症、抑郁症、智力障碍、神经梅毒、莱施-尼汉综合征和脑结构性病变。
