title: Self-Enucleation and Severe Ocular Injury in the Psychiatric Setting.
abstract: BACKGROUND
  Although the first medically-reported case of auto-enucleation was described in the mid-19th century, ocular self-gouging has long been depicted in historical legend and mythology. Cases of enucleation have since been identified across various cultures. Though relatively uncommon, this major form of self-mutilation now afflicts approximately 500 individuals per year, and may present more commonly among certain clinical populations.
  
  
  METHODS
  We present 2 cases of self-enucleation in patients with psychotic illnesses and review existing literature on the history of enucleation, associated pathology, and management (both medically and psychiatrically) for this serious form of self-injury.
  
  
  RESULTS
  Literature review includes a brief historical perspective of auto-enucleation and its context in psychosomatic medicine, with cases to highlight key aspects in the prevention and management of ocular self-injury. Normal eye pathology is described briefly, with a focus on medical care after self-inflicted damage, as pertinent to consultation psychiatrists. Interventions for behavioral and pharmacologic management of agitation and impulsivity are reviewed, including consideration for electroconvulsive therapy, in this particular context.
  
  
  CONCLUSIONS
  Although severe ocular self-injury is uncommon, psychiatrists should be familiar with approaches to prevent and manage auto-enucleation in individuals at risk thereof. Consultation psychiatrists must work closely with ophthalmologists to address affective, behavioral, and cognitive triggers and complications of ocular self-injury.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Clinebell
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA. Electronic address: valpeyre@upmc.edu.
authors.forename: Robin
authors.initials: R
authors.lastname: Valpey
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Walker
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA.
authors.forename: Priya
authors.initials: P
authors.lastname: Gopalan
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Azzam
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D005131:Eye Injuries / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000209:etiology; D013508:Ophthalmologic Surgical Procedures; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012652:Self Mutilation / Q000523:psychology* / Q000628:therapy
chemical_list: D014150:Antipsychotic Agents