Drug induced autoenucleation with resultant chiasmal damage

Self enucleation or “oedipism”¹ is a rare form of self mutilation, occurring with paranoid delusions, either as a result of a drug related toxic psychosis or in functional psychoses, such as schizophrenia. It is most often described in acutely psychotic patients, who have religious or sexual delusions.²

We report a case of self enucleation of a right eye in a 19 year old male—induced by drug psychosis. The force of autoenucleation traumatised the chiasm resulting in a left temporal field defect. Only two cases of contralateral field defect secondary to chiasmal damage have been reported in the literature.^3,4 Many drugs are known to cause hallucination leading to self mutilation.

Deliberate self harm (DSH)⁵ is a well known entity which varies from mild (skin picking and hair pulling) to severe forms of self mutilation like self amputation and self enucleation.⁵ DSH is known to result from delusions and command hallucinations occurring in psychotic and mood disorders, dementia, personality disorder, drug misuse, and mental retardation. In adults, …