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Chapter 11: Ophthalmology

Case 11-1: Autoenucleation

Patient Presentation

A young patient presented with alcoholic hallucinosis. The patient had reportedly autoenucleated his eye.

Figure 11-1.

Autoenucleated eye

The image shows an autonucleated eye; in a patient who autonucleated his own eye under alcoholic hallucinosis.
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Clinical Features

The patient had an obvious enucleation of his eye.

Differential Dx

  • Altered mental status secondary to toxicologic exposure

  • Central nervous system disorder

  • Metabolic or endocrine disorder

  • Psychiatric disease

Emergency Care

The patient had no other injuries and was admitted to the hospital for further management of his self-enucleation and alcoholic hallucinosis.

Outcome

This patient was lost to follow-up.

Key Learning Points

  • Alcohol hallucinosis develops 12 to 24 hours after the last alcohol ingestion, generally lasts 1 to 2 days, and the hallucinations are most often visual, although auditory and tactile hallucinations can also occur.

  • Alcohol hallucinosis is not related to delirium tremens.

  • Patients maintain a clear sensorium, and thus they are aware they are experiencing hallucinations.

  • Autoenucleation is most common in the context of significant psychiatric disease.

Further Reading

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Fan  AH. Autoenucleation: a case report and literature review. Psychiatry (Edgmont). 2007;4(10):60–62.  [PubMed: 20428312]
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Gamulescu  MA, Serguhn  S, Aigner  JM, Lohmann  CP, Roider  J. Enucleation as a form of self-aggression—2 case reports and review of the literature [in German]. Klinische Monatsblatter Fur Augenheilkunde. 2001;218(6):451–454.  [PubMed: 11488013]
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Imes  RK. Drug induced autoenucleation with resultant chiasmal damage. Br J Ophthalmol. 2005;89(6):783.  [PubMed: 15923529]
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Kennedy  BL, Feldmann  TB. Self-inflicted eye injuries: case presentations and a literature review. Hosp Community Psychiatry. 1994;45(5):470–474.  [PubMed: 8045543]
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Tabatabaei  SA, Soleimani  M, Khodabandeh  A. A case of autoenucleation associated with a contralateral field defect. Orbit. 2011;30(3):165–168.  [PubMed: 21574809]
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Zhang  M, Tanaka  S, Mercier  M,  et al. Gender and racial disparities in cases of autoenucleation. Semin Ophthalmol. 2016;31(4):415–425.  [PubMed: 27142085]

Case 11-2: High-pressure injection of air into the orbit

Patient Presentation

A 3-year-old child accidentally injected her orbit with a high-pressure air hose.

Figure 11-2.

Left periorbital swelling with palpable subcutaneous emphysema

The image shows a swelling over the left periorbital area in a child who accidentally injected her orbit with a high-pressure air hose.
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Figure 11-3.

Noncontrast head CT scan (bone windows). WA = orbital air, WDA = pneumocephaly

The image shows a non-contrast head CT scan in the patient with left periorbital swelling.
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Clinical Features

The patient had a markedly swollen left periorbital area. Subcutaneous emphysema could be palpated.

Differential Dx

  • Ocular injury

  • Intracranial injury

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