Multiple Penetrating Eye Wounds Due to Suspected Self-Injury

We present a case of a 29-year-old male night watchman complaining of sudden decreased vision, redness, and tearing of the left eye. On anamnesis, trauma was denied and personal past history was relevant for right eye enucleation due to an "eye injury" 8 years prior. At presentation, his visual acuity was 20/200 and intraocular pressure (IOP) was 10 mmHg. Slit lamp examination revealed a 1-mm inferonasal corneal wound and a localized lens opacity associated with extrusion and posterior extension of cortical material in the same quadrant. Echography confirmed posterior lens capsular bag puncture with hyperechogenic material in the anterior vitreous. Intraocular foreign body was ruled out. Topical anti-inflammatory and cycloplegic treatment was initiated with partial visual recovery, IOP rise, moderate anterior chamber inflammatory reaction, and an emergent posterior subcapsular cataract. A pars plana vitrectomy and lensectomy were performed. After surgery and recovery, best-corrected visual acuity with contact lens was 20/15. The patient was followed for 6 years, during which he returned 6 more times with a variety of new findings, such as new corneal leukoma, leaking corneal wounds, hypotony, choroidal folds, and choroidal detachments, each time with full visual acuity recovery. Some cases of ocular injury and self-mutilation have been described in the context of various psychiatric disorders. Self-inflicted injuries were suspected due to substance abuse, although the patient denied doing so. Referral to a psychiatrist was insisted on several occasions without success. However, potentially life-threatening complications may arise; therefore, psychiatric referral is imperative.