Automutilation of the cornea. I. Ophthalmological aspects

Automutilation of the cornea occurs more frequently than is generally supposed. The patient, particularly at his first visit, certainly will not reveal the cause of the cornea lesion. In two University Eye Clinics 19 patients were seen in whom the diagnosis of automutilation of the cornea could be made. It is important for the ophthalmologist to bear the possibility of automutilation in mind. In 6 of our patients corneal grafts were performed. All these grafts failed because of further automutilation. Corneal transplantation is certainly not indicated; these operations were performed because the patient's true condition had not been spotted in time. Better forms of treatment are tarsorrhaphy or the application of closely occluding bandages. In this way fair results were obtained in 2 cases. It is wrong to force the patient to a confrontation (i.e. to tell him that automutilation is suspected). Confrontation can lead to more severe mental disorders. In all cases psychiatric treatment is absolutely essential. The ophthalmological prognosis for this condition is poor and psychiatric help is quite often refused.