Autoenucleation as a form of self-mutilation - two case reports and a literature review

Background: Autoenucleation is the worst form of self-mutilation of the eye . Patients affected are mostly those with psychosis and delusions. but such acts can also happen under the influence of drugs, alcohol, solvents and s eldom with organic illnesses. Often, these patients are known to be autoagg ressive and suicidal. Patients: We present two psychiatric patients who autoenucleated one eye an d injured the other. A 41-year-old patient with known organic epilepsy base d on a temporal-lobe-hemangioma and psychosis with delusions autoenucleated his right eye and lacerated the conjunctiva of the other, following impera tive voices. A 50-year-old female suffered from a longstanding paranoid sch izophrenia and religious delusions, and autoaggressive acts with resulting amaurosis of the right eye and several suicidal attempts had preceded the a utoenucleation of the left eye. Discussion: After the completion of the autoaggressive act the patients exp erience relief, but often the autoaggresive or suicidal impulses persist or recur. A close cooperation between ophthalmologists and psychiatrist in th ese patients is imperative.