Self-inflicted enucleations: Clinical features of seven cases

Mamta Shah, Lucy Sun, Solly Elmann, Ivan Vrcek, Ronald Mancini, Hee Joon Kim, Jacqueline Carrasco, Roman Shinder

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We report the clinical presentation, radiography, and management outcomes of autoenucleations (AE). Charts of 7 patients evaluated at 4 institutions with AE were reviewed. Four males and three females had a mean age of 50 years (range 26–72 years). The etiologies were psychosis secondary to underlying mental illness (6, 88%) and substance use (1, 12%), and the mechanism was largely blunt digital injury (6, 88%). Three (43%) AE patients suffered bilateral enucleations. Common concomitant injuries included eyelid lacerations (5, 71%) and optic nerve avulsion (3, 43%). Radiography was utilized for all of the study patients with computed tomography as the most common (5, 71%), followed by ultrasound (1, 14%), and magnetic resonance imaging with CT angiography (1, 14). Orbital exploration was performed in the management of all patients. Orbital implants were placed in 4 (57%) patients. Patients were followed for a mean of 1.9 months (range 1–4 months). Autoenucleation affects both genders and is commonly associated with eyelid lacerations, optic nerve avulsion, and intracranial hemorrhage. The association with intracranial hemorrhage is consistent with prior reports of internal carotid artery injury following shearing of the optic nerve. Autoenucleation cases were seen secondary to mental or substance induced psychosis, and these patients may be at risk for future injuries such as AE of the contralateral globe. The common causes for psychosis reported our patient group include schizophrenia, depression, schizoaffective disorder, and methamphetamine-induced psychosis, which corroborates with similar cases in the literature. Two of three cases of bilateral AE suffered sequential AE where the contralateral globe was enucleated days apart. All patients suffering AE should have full medical, psychiatric, neurologic, and radiologic evaluation and monitoring while under care. When evaluating patients with obvious ocular injury, accompanying intracranial injuries should be ruled out in a timely fashion before pursuing surgical intervention.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalOrbit
DOIs
StateAccepted/In press - Mar 5 2017

Fingerprint

Psychotic Disorders
Optic Nerve Injuries
Intracranial Hemorrhages
Lacerations
Eyelids
Radiography
Wounds and Injuries
Substance-Induced Psychoses
Orbital Implants
Carotid Artery Injuries
Eye Injuries
Nonpenetrating Wounds
Methamphetamine
Internal Carotid Artery
Optic Nerve
Nervous System
Psychiatry
Schizophrenia
Tomography
Magnetic Resonance Imaging

Keywords

  • Autoenucleation
  • enucleation
  • globe
  • optic nerve avulsion
  • psychosis

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Shah, M., Sun, L., Elmann, S., Vrcek, I., Mancini, R., Kim, H. J., ... Shinder, R. (Accepted/In press). Self-inflicted enucleations: Clinical features of seven cases. Orbit, 1-5. https://doi.org/10.1080/01676830.2017.1279670

Self-inflicted enucleations : Clinical features of seven cases. / Shah, Mamta; Sun, Lucy; Elmann, Solly; Vrcek, Ivan; Mancini, Ronald; Kim, Hee Joon; Carrasco, Jacqueline; Shinder, Roman.

In: Orbit, 05.03.2017, p. 1-5.

Research output: Contribution to journalArticle

Shah, M, Sun, L, Elmann, S, Vrcek, I, Mancini, R, Kim, HJ, Carrasco, J & Shinder, R 2017, 'Self-inflicted enucleations: Clinical features of seven cases', Orbit, pp. 1-5. https://doi.org/10.1080/01676830.2017.1279670
Shah, Mamta ; Sun, Lucy ; Elmann, Solly ; Vrcek, Ivan ; Mancini, Ronald ; Kim, Hee Joon ; Carrasco, Jacqueline ; Shinder, Roman. / Self-inflicted enucleations : Clinical features of seven cases. In: Orbit. 2017 ; pp. 1-5.
@article{6275773126274dddaf3839f4f692b35b,
title = "Self-inflicted enucleations: Clinical features of seven cases",
abstract = "We report the clinical presentation, radiography, and management outcomes of autoenucleations (AE). Charts of 7 patients evaluated at 4 institutions with AE were reviewed. Four males and three females had a mean age of 50 years (range 26–72 years). The etiologies were psychosis secondary to underlying mental illness (6, 88{\%}) and substance use (1, 12{\%}), and the mechanism was largely blunt digital injury (6, 88{\%}). Three (43{\%}) AE patients suffered bilateral enucleations. Common concomitant injuries included eyelid lacerations (5, 71{\%}) and optic nerve avulsion (3, 43{\%}). Radiography was utilized for all of the study patients with computed tomography as the most common (5, 71{\%}), followed by ultrasound (1, 14{\%}), and magnetic resonance imaging with CT angiography (1, 14). Orbital exploration was performed in the management of all patients. Orbital implants were placed in 4 (57{\%}) patients. Patients were followed for a mean of 1.9 months (range 1–4 months). Autoenucleation affects both genders and is commonly associated with eyelid lacerations, optic nerve avulsion, and intracranial hemorrhage. The association with intracranial hemorrhage is consistent with prior reports of internal carotid artery injury following shearing of the optic nerve. Autoenucleation cases were seen secondary to mental or substance induced psychosis, and these patients may be at risk for future injuries such as AE of the contralateral globe. The common causes for psychosis reported our patient group include schizophrenia, depression, schizoaffective disorder, and methamphetamine-induced psychosis, which corroborates with similar cases in the literature. Two of three cases of bilateral AE suffered sequential AE where the contralateral globe was enucleated days apart. All patients suffering AE should have full medical, psychiatric, neurologic, and radiologic evaluation and monitoring while under care. When evaluating patients with obvious ocular injury, accompanying intracranial injuries should be ruled out in a timely fashion before pursuing surgical intervention.",
keywords = "Autoenucleation, enucleation, globe, optic nerve avulsion, psychosis",
author = "Mamta Shah and Lucy Sun and Solly Elmann and Ivan Vrcek and Ronald Mancini and Kim, {Hee Joon} and Jacqueline Carrasco and Roman Shinder",
year = "2017",
month = "3",
day = "5",
doi = "10.1080/01676830.2017.1279670",
language = "English (US)",
pages = "1--5",
journal = "Orbit",
issn = "0167-6830",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Self-inflicted enucleations

T2 - Clinical features of seven cases

AU - Shah, Mamta

AU - Sun, Lucy

AU - Elmann, Solly

AU - Vrcek, Ivan

AU - Mancini, Ronald

AU - Kim, Hee Joon

AU - Carrasco, Jacqueline

AU - Shinder, Roman

PY - 2017/3/5

Y1 - 2017/3/5

N2 - We report the clinical presentation, radiography, and management outcomes of autoenucleations (AE). Charts of 7 patients evaluated at 4 institutions with AE were reviewed. Four males and three females had a mean age of 50 years (range 26–72 years). The etiologies were psychosis secondary to underlying mental illness (6, 88%) and substance use (1, 12%), and the mechanism was largely blunt digital injury (6, 88%). Three (43%) AE patients suffered bilateral enucleations. Common concomitant injuries included eyelid lacerations (5, 71%) and optic nerve avulsion (3, 43%). Radiography was utilized for all of the study patients with computed tomography as the most common (5, 71%), followed by ultrasound (1, 14%), and magnetic resonance imaging with CT angiography (1, 14). Orbital exploration was performed in the management of all patients. Orbital implants were placed in 4 (57%) patients. Patients were followed for a mean of 1.9 months (range 1–4 months). Autoenucleation affects both genders and is commonly associated with eyelid lacerations, optic nerve avulsion, and intracranial hemorrhage. The association with intracranial hemorrhage is consistent with prior reports of internal carotid artery injury following shearing of the optic nerve. Autoenucleation cases were seen secondary to mental or substance induced psychosis, and these patients may be at risk for future injuries such as AE of the contralateral globe. The common causes for psychosis reported our patient group include schizophrenia, depression, schizoaffective disorder, and methamphetamine-induced psychosis, which corroborates with similar cases in the literature. Two of three cases of bilateral AE suffered sequential AE where the contralateral globe was enucleated days apart. All patients suffering AE should have full medical, psychiatric, neurologic, and radiologic evaluation and monitoring while under care. When evaluating patients with obvious ocular injury, accompanying intracranial injuries should be ruled out in a timely fashion before pursuing surgical intervention.

AB - We report the clinical presentation, radiography, and management outcomes of autoenucleations (AE). Charts of 7 patients evaluated at 4 institutions with AE were reviewed. Four males and three females had a mean age of 50 years (range 26–72 years). The etiologies were psychosis secondary to underlying mental illness (6, 88%) and substance use (1, 12%), and the mechanism was largely blunt digital injury (6, 88%). Three (43%) AE patients suffered bilateral enucleations. Common concomitant injuries included eyelid lacerations (5, 71%) and optic nerve avulsion (3, 43%). Radiography was utilized for all of the study patients with computed tomography as the most common (5, 71%), followed by ultrasound (1, 14%), and magnetic resonance imaging with CT angiography (1, 14). Orbital exploration was performed in the management of all patients. Orbital implants were placed in 4 (57%) patients. Patients were followed for a mean of 1.9 months (range 1–4 months). Autoenucleation affects both genders and is commonly associated with eyelid lacerations, optic nerve avulsion, and intracranial hemorrhage. The association with intracranial hemorrhage is consistent with prior reports of internal carotid artery injury following shearing of the optic nerve. Autoenucleation cases were seen secondary to mental or substance induced psychosis, and these patients may be at risk for future injuries such as AE of the contralateral globe. The common causes for psychosis reported our patient group include schizophrenia, depression, schizoaffective disorder, and methamphetamine-induced psychosis, which corroborates with similar cases in the literature. Two of three cases of bilateral AE suffered sequential AE where the contralateral globe was enucleated days apart. All patients suffering AE should have full medical, psychiatric, neurologic, and radiologic evaluation and monitoring while under care. When evaluating patients with obvious ocular injury, accompanying intracranial injuries should be ruled out in a timely fashion before pursuing surgical intervention.

KW - Autoenucleation

KW - enucleation

KW - globe

KW - optic nerve avulsion

KW - psychosis

UR - http://www.scopus.com/inward/record.url?scp=85014466903&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014466903&partnerID=8YFLogxK

U2 - 10.1080/01676830.2017.1279670

DO - 10.1080/01676830.2017.1279670

M3 - Article

C2 - 28594303

AN - SCOPUS:85014466903

SP - 1

EP - 5

JO - Orbit

JF - Orbit

SN - 0167-6830

ER -