title: Optic nerve massaging: an extremely rare cause of self-inflicted blindness.
abstract: OBJECTIVE
  To report a patient whose self-inflicted blindness was not clinically apparent by history or external signs of trauma.
  
  
  METHODS
  Observational case report.
  
  
  METHODS
  A 12-year-old girl with a history of social and behavioral problems was noted to have visual loss in her right eye. Examination revealed no light perception, optic nerve atrophy, partial upper lid ptosis, exotropia, and hypoesthesia of the cheek, all on her right side.
  
  
  RESULTS
  After undergoing extensive examinations which were unrevealing for a diagnosis, the patient admitted to a recurrent maneuver, which she secretly used to relieve anxiety and stress. This maneuver consisted of inserting her index finger under the right supraorbital rim and forcibly subluxating her globe out of the orbital space.
  
  
  CONCLUSIONS
  Self-inflicted visual loss can occur in nonpsychotic and nonviolent patients. Accurate diagnosis is important, as there is a risk of similar involvement to the fellow eye, and referral for psychiatric counseling is mandatory.
authors.affiliation: Hopital Ophtalmique Jules Gonin, Lausanne, Switzerland. francois.borruat@ophtal.vd.ch
authors.forename: Francois-Xavier
authors.initials: FX
authors.lastname: Borruat
authors.forename: Aki
authors.initials: A
authors.lastname: Kawasaki
mesh_terms: D001766:Blindness / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D002648:Child; D005094:Exophthalmos / Q000209:etiology; D005099:Exotropia / Q000209:etiology; D005260:Female; D006801:Humans; D008405:Massage / Q000009:adverse effects*; D009900:Optic Nerve; D020221:Optic Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D012652:Self Mutilation / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology