Autoenucleation in a 84-year-old dementia patient

Autoenucleation is a severe, rare form of self-mutilation. The majority of cases have been reported in the 15- to 60-year age group, usually in psychiatric patients with a history of depression or schizophrenia, sometimes caused by drug abuse.

We report a case of left-sided autoenucleation in an 84-year-old dementia patient suffering from reactive depression. Medical reports mentioned a suicide attempt 2 weeks prior to the incident, whereupon the patient was admitted to the locked ward of a psychiatric hospital. During one night of inpatient stay, the patient manually autoenucleated his left eye. Inspection of the enucleated organ revealed a completely intact globe with an attached optic nerve 5.5 cm in length. The orbit was filled with a massive haematoma. A contrast-enhanced computed tomography (CT) scan showed an orbital haematoma, absence of the left globe and optic nerve and a chiasmatic lesion, accompanied by an intracranial bleeding into the subarachnoid space. Primary wound closure was performed without complications. Visual acuity of the right eye could not be tested due to the patient's lack of cooperation.

To the best of our knowledge, this is the only reported case of an elderly patient with primary dementia who performed autoenucleation. Other aspects, such as patient history, suicide attempt, manual eye extraction and chiasma lesion are similar to cases reported earlier. The identification and evaluation of intracranial bleedings and chiasmatic lesions that can be associated with autoenucleation requires a contrast-enhanced CT, especially if a long optic nerve fragment is attached to the enucleated globe.