Traumatic Globe Enucleation After Blunt Head Injury.

We report a 57-year-old female with left globe enucleation following head trauma after falling. The left globe was intact and protruded from the orbit. A CT scan revealed anterior globe protrusion with avulsions of the optic nerve and the extraocular muscles with posterior-lateral dislocation of the left lateral orbital wall. Due to the unstable general condition (with signs of intracranial hemorrhage), the patient was admitted to the ICU, and the removal of the completely avulsed globe was postponed. After stabilizing the general condition, the avulsed globe with adjacent structures including a part of the optic nerve was removed in the operation theater and the patient was planned for future orbital reconstructive surgeries including ocular prosthesis. The patient underwent close follow-up visits during the admission for detecting any signs of sympathetic ophthalmia progression in the fellow eye. Traumatic enucleation is a rare condition and can be caused not only by direct and high-energy traumas, but also by the indirect mode of trauma with no significant orbital wall disassembly. In these patients, predisposition to globe luxation must be considered and advised for protecting the fellow eye from any traumas.

Oedipism: An unusual case of auto-enucleation including mechanism of avulsion.

INTRODUCTION: Self-inflicted enucleation, also known as auto-enucleation (AE) or Oedipism, is an uncommon and severe form of ocular injury which presents as an ophthalmic and psychiatric emergency. Usually known to occur with untreated psychosis, this case is a rare report which demonstrates AE as a result of a subsequently diagnosed drug induced psychosis. We report the clinical presentation, management and for the first time a detailed speculative account about the mechanism of AE, based on our clinicopathologic findings. CASE REPORT: A 53-year old Afro-Caribbean patient was arrested following an altercation and was incarcerated awaiting arraignment. The patient had no previous psychiatric history but tested positive for cannabis, opiates and cocaine as well as admitting to illicit drug use in the community. Whilst in custody, the patient self-enucleated his right eye. The patient declined consent to eye examination and was subsequently admitted under section 2 of the Mental Health Act. After full work-up including Goldmann visual fields and magnetic resonance imaging, he underwent right orbital exploration under anesthetic where AE was confirmed whilst the left eye showed evidence of attempted enucleation. The residual tenons and conjunctiva was subsequently repaired without placement of an orbital implant in the right orbit. The globe was sent for histology which revealed clues to the potential mechanism of auto-enucleation. CONCLUSION: This case is unique as it offers an alternative presentation to those most commonly reported in the current literature, highlights the sparsity of literature detailing the mechanism of AE and stimulates discussion around various potential systemic etiological differential diagnoses, management strategies and complications of AE.

A Case of Self-Enucleation in an Incarcerated Patient: Case Report and Review of Literature.

Self-enucleation is a severe form of self-injurious behavior which presents as an ophthalmologic and psychiatric emergency. It is usually known to occur with untreated psychosis, however, there have been reports of self-enucleation across various psychopathologies. We review a case documenting self-enucleation in the forensic setting in a patient with an unusual presentation and cluster of psychotic symptoms. Literature was reviewed using PubMed/Medline databases with key terms: "forensic science," "forensic psychiatry," "auto-enucleation," "self-enucleation," "Oedipism," "self-harm." This case is unique as it offers an alternative presentation to those most commonly depicted in current literature, helps highlight the sparsity of literature depicting self-enucleation in the forensic setting, and stimulates discussion around various potential differential diagnoses, management strategies and complications of self-enucleation within the forensic setting. It is prudent to emphasize need for aggressive and collaborative treatment for the forensic population regardless of psychopathology, presentation, or propensity for secondary gain.