Bilateral acute endophthalmitis associated with munchausen syndrome

Endophthalmitis is a potentially blinding intraocular infection that requires urgent intervention. Self-inflicted endophthalmitis is rare, difficult to diagnose, and requires a multidisciplinary approach for management. The purpose is to present a rare case of sequential self-inflicted acute endophthalmitis as a feature of Munchausen syndrome.

This is a case report reviewing imaging and laboratory studies.

A 42-year-old female patient developed culture-proven acute endophthalmitis sequentially in both eyes with different bacterial strains. There was clear evidence of self-inflicted corneal puncture tracks in the right eye, and during the course of inpatient psychiatric evaluation, the patient admitted to self-inflicted ocular perforations.

Patients with Munchausen syndrome often injure themselves as a method of drawing attention, sympathy, or reassurance. Although ocular injuries due to psychiatric disease are known to occur, intraocular injection as a mode of self-injury is extremely rare. A high index of suspicion must be maintained when the reported history and clinical course are inconsistent.