title: Complications and outcomes after autoenucleation.
abstract: OBJECTIVE
  Autoenucleation has long been described in the literature, dating back as far as the 4th century AD. Within a 3-month period, two patients were admitted to our hospital after autoenucleation. A comprehensive review of the literature was performed to identify trends in, risk factors for, and potential life-threatening complications of autoenucleation.
  
  
  RESULTS
  Two adult Caucasian men were transferred from outside hospitals after autoenucleation. One patient's urine tested positive for methamphetamines, and the second patient had a history of schizophrenia. In both cases, imaging of the head and orbits was performed to rule out secondary sequelae after self-enucleation. Patient one did not have any intracranial abnormalities. Patient 2 had a head computed tomography scan that showed a left internal carotid artery dissection, subarachnoid hemorrhage, and basal ganglia/thalamic stroke. Review of the literature revealed that almost all cases were associated with underlying mental illness and/or a history of drug abuse.
  
  
  CONCLUSIONS
  Autoenucleation occurs more frequently in patients with psychiatric illness or drug abuse. It can be a devastating injury, not only locally, but neurologically. Ophthalmologists should be aware of the potentially life-threatening consequences of autoenucleation.
authors.affiliation: aDepartment of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma bDepartment of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts cDepartment of Ophthalmology and Visual Sciences dDepartment of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Gauger
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Sobel
authors.forename: Richard C
authors.initials: RC
authors.lastname: Allen
mesh_terms: D000328:Adult; D015353:Eye Enucleation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D019966:Substance-Related Disorders; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome