Severe ocular self-injury.

To further delineate the clinical characteristics of patients who deliberately, severely mutilate their eyes, we reviewed the medical records of a specialty eye hospital and found nine cases of intentional, severe, self-inflicted eye injuries. We identified two groups of patients. Most were young psychotic individuals with severe psychopathology often involving sexual and religious delusions, command hallucinations, and the propensity to act on delusions. The second group was comprised of patients with organic disabilities, either dementia or severe mental retardation, where a lack of impulse control and preexisting eye irritation or surgical operation may have contributed to the act. One patient was a recidivist. Two-thirds of the patients were confined at the time of the act. That self-mutilation may occur frequently in confined patients calls for active vigilance from caretakers; that it may recur calls for caution by the psychiatrist.