Autoenucleation attempt associated with cannabis use from chemotherapy related symptom management --

Abstract

Introduction
Autoenucleation has been previously reported in cases of patients with acute psychosis, frequently related to methamphetamine use, in the setting of religious preoccupation. While literature review revealed multiple cases of methamphetamine-induced psychosis resulting in self-induced eye trauma, there is only one other case found with associated cannabis use and unintentional self-enucleation from “eye rubbing” in a patient with comorbid psychiatric conditions. We describe a case of attempt at bilateral self-enucleation for religious atonement, resulting in ruptured globe, in a patient with no prior psychiatric history, who was using cannabis as an antiemetic in the setting of chemotherapy for his lymphoma.
Report
A 46-year-old man with a past medical history of Hodgkin’s lymphoma and cannabis use presented for self-inflicted bilateral eye trauma and presumed substance related psychosis with religious preoccupation. External examination was difficult to obtain with little cooperation, noted significant periorbital ecchymosis with blood leading from palpebral fissure and resistance to retropulsion of the right eye, with less significant but notable eyelid ecchymosis and swelling of the left eyelids and blood in the maxillary region. Computed tomography of the orbits revealed right globe rupture with periorbital hematoma and intravitreal hemorrhage. The patient was taken for urgent surgical exploration and globe repair. Urine drug screening positive for THC. He was admitted to an inpatient psychiatric unit once stable postoperatively. He acknowledged literal interpretation of a biblical verse for attempt to self-enucleate as a punishment and was declining evaluation or treatment for lessening his punishment. Cannabis use stemmed from self-initiation with chemotherapy symptom management and progressed beyond his chemotherapy treatment with increased usage.
Conclusion
This is the first reported case of self-enucleation attempt in the setting of religious preoccupied psychosis associated with cannabis use stemming from chemotherapy symptom management. Examination and repair are complicated by substance use and religious preoccupation.