A 26-year-old Negro male schizophrenic is described with severe bilateral orbital injuries following attempted self-enucleation. Owing to his psychosis there was difficulty in obtaining a visual acuity and in establishing the cause of his fixed, dilated pupils. ACT scan showed bilateral orbital oedema, with surgical emphysema and haemorrhage. The visual evoked potential (VEP) was present in the right eye but absent in the left. High doses of systemic steroids effected rapid resolution of the orbital swelling and recovery of the vision in the right eye. The effects of self-inflicted injury to the orbital content and the value of sophisticated investigation in this unusual case are discussed.
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