title: Bilateral corneal perforations and autoproptosis as self-induced manifestations of ocular Munchausen's syndrome.
abstract: OBJECTIVE
  To report a patient with bilateral corneal perforations and autoproptosis in a case of ocular Munchausen's syndrome.
  
  
  METHODS
  Case report.
  
  
  METHODS
  A 26-year-old white male referred to the oculoplastics service with one month history of decreased vision bilaterally and painful right eye. Multiple eyelid scars and right corneal opacity were noted. The patient was previously seen at another institution for rapid loss of vision in both eyes.
  
  
  METHODS
  An orbit decompression among many procedures failed to controlled extreme pain and proptosis.
  
  
  METHODS
  Resolution of proptosis, stabilization of vision, pain resolution.
  
  
  RESULTS
  Three weeks after enucleation of the right eye was offered, patient presented with spontaneous left ruptured globe. After multiple episodes of self-mutilation and infections, both eyes were exenterated.
  
  
  CONCLUSIONS
  Munchausen syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnosis when ocular abnormalities cannot be explained after a thorough evaluation. Recognition of this psychiatric disease is not only important for correct medical diagnosis and treatment, but also essential in protecting the patients from unnecessary invasive and aggressive medical procedures.
authors.affiliation: Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Lin
authors.forename: J Javier
authors.initials: JJ
authors.lastname: Servat
authors.forename: Carlo R
authors.initials: CR
authors.lastname: Bernardino
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
authors.forename: Flora
authors.initials: F
authors.lastname: Levin
mesh_terms: D000328:Adult; D065306:Corneal Injuries; D057112:Corneal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D019299:Decompression, Surgical; D005094:Exophthalmos / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D017234:Eye Evisceration; D005131:Eye Injuries / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D058447:Eye Pain / Q000209:etiology; D005143:Eyelids / Q000293:injuries; D006801:Humans; D008297:Male; D009110:Munchausen Syndrome / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D009915:Orbit / Q000601:surgery; D012652:Self Mutilation / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D014786:Vision Disorders / Q000209:etiology