Okafor Linda, Choudry Abid, Mudhar Hardeep S, Sandramouli Soupramanien
Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Department of Psychiatry, Black Country Healthcare Foundation Trust, Penn Hospital, Wolverhampton, UK.
Eur J Ophthalmol. 2020 Nov 13:1120672120972028. doi: 10.1177/1120672120972028.
Self-inflicted enucleation, also known as auto-enucleation (AE) or Oedipism, is an uncommon and severe form of ocular injury which presents as an ophthalmic and psychiatric emergency. Usually known to occur with untreated psychosis, this case is a rare report which demonstrates AE as a result of a subsequently diagnosed drug induced psychosis. We report the clinical presentation, management and for the first time a detailed speculative account about the mechanism of AE, based on our clinicopathologic findings.
A 53-year old Afro-Caribbean patient was arrested following an altercation and was incarcerated awaiting arraignment. The patient had no previous psychiatric history but tested positive for cannabis, opiates and cocaine as well as admitting to illicit drug use in the community. Whilst in custody, the patient self-enucleated his right eye. The patient declined consent to eye examination and was subsequently admitted under section 2 of the Mental Health Act. After full work-up including Goldmann visual fields and magnetic resonance imaging, he underwent right orbital exploration under anesthetic where AE was confirmed whilst the left eye showed evidence of attempted enucleation. The residual tenons and conjunctiva was subsequently repaired without placement of an orbital implant in the right orbit. The globe was sent for histology which revealed clues to the potential mechanism of auto-enucleation.
This case is unique as it offers an alternative presentation to those most commonly reported in the current literature, highlights the sparsity of literature detailing the mechanism of AE and stimulates discussion around various potential systemic etiological differential diagnoses, management strategies and complications of AE.
自我摘除眼球，也称为自体眼球摘除术（AE）或自残性眼球摘除，是一种罕见且严重的眼部损伤形式，表现为眼科和精神科急症。通常已知其发生于未经治疗的精神病患者中，本病例是一份罕见报告，显示AE是由随后诊断出的药物性精神病导致的。我们报告了临床表现、治疗情况，并首次基于临床病理结果对AE的机制进行了详细的推测性阐述。
一名53岁的非洲裔加勒比海患者在一次争吵后被捕，并被监禁等待 arraignment。该患者既往无精神病史，但大麻、阿片类药物和可卡因检测呈阳性，且承认在社区中使用非法药物。在羁押期间，患者自行摘除了右眼。患者拒绝同意眼部检查，随后根据《精神健康法》第2条入院。经过包括Goldmann视野检查和磁共振成像在内的全面检查后，他在麻醉下接受了右眼眶探查，术中证实为AE，而左眼有试图摘除眼球的迹象。随后修复了右眼残留的Tenon囊和结膜，未在右眼眶植入眼眶植入物。将眼球送去做组织学检查，结果揭示了自体眼球摘除潜在机制的线索。
本病例独特之处在于，它呈现出与当前文献中最常报道的情况不同的表现形式，突出了详细阐述AE机制的文献的稀缺性，并引发了围绕AE各种潜在的全身病因鉴别诊断、治疗策略及并发症的讨论。
