Self-Enucleation of One Eye and Contra-Lateral Field Defect

Dear Editor

Large et al. raised interesting points about our case report published in June.¹ However, there are some points about their letter. They mentioned that in their review of literature,² among the 30 reported autoenucleation, there were four cases with contralateral hemianopia during 50 years. It is obvious that publishing such cases of autoenucleation in journals needs some unusual association to be interesting especially in recent years. Most of these reported cases were published because of another association such as contralateral field loss or other complications, a drug induced psychosis or existence of any self-mutilation of the other eye.² Thus we can not conclude a percent of 13.5% (4/30) because all cases of autoenucleation have not been reported. Apparently reporting four cases of autoenucleation associated with contralateral field deficit during 50 years shows the rare incidence of such an event. However, it is important to rule out such a complication in a patient with self-enucleation.

About the follow-up and management, the patient underwent psychiatric consultation. Because of severe psychosis, paranoid thoughts and hallucination, the patient was restrained, treated with benzodiazepines and intramuscular neuroleptics (1 mg intramuscular diazepam and 15 mg intramuscular haloperidol that was changed to oral haloperidol 20 mg daily after 3 days).The patient received oral haloperidol 20 mg, oral trihexyphenidyl 10 mg and oral chlorpromazine 100 mg, daily. Gradually, symptoms and signs decreased and the patient developed some insight to his disorder and expressed extreme regret for the self-enucleation. After 2 months, the drugs were tapered and the patient received psychotherapy and cognitive behavior therapy.³

Declaration of interest: The author reports no conflicts of interest. The authors alone are responsible for the content and writing of the paper.