Self-inflicted ocular mutilation.

Self-inflicted mutilation of the eyes is an uncommon but fairly distinct entity. Patients are typically young men; they often have criminal records and histories of drug abuse. Underlying schizophrenia is a common feature. The patients frequently suffer from castration fears, oedipal conflicts, repressed homosexual impulses, severe guilt, and a need for punishment. We treated two patients with this disorder. The first, a 26-year-old prison inmate convicted of murdering his grandfather, cut his eyes with a razor blade. He had previously attempted to commit suicide, suffered from delusions, and experienced auditory hallucinations. Surgical repair of his injuries improved his visual acuity to R.E.: 6/15 (20/50) and L.E.: 6/30 (20/100). The second patient, a 24-year-old inmate of a mental institution, had previously undergone a lensectomy for a hypermature cataract induced by a self-inflicted lye burn in his left eye. One year later, he was treated for lacerations of his right eye and partial amputation of his tongue. In the year between admissions, he had enucleated his left eye. Visual acuity in his remaining eye was no light perception, so no surgery was performed.