ECT post eye surgery: two cases and a review of the literature

Self-Enucleation and Severe Ocular Injury in the Psychiatric Setting

BACKGROUND

Although the first medically-reported case of auto-enucleation was described in the mid-19th century, ocular self-gouging has long been depicted in historical legend and mythology. Cases of enucleation have since been identified across various cultures. Though relatively uncommon, this major form of self-mutilation now afflicts approximately 500 individuals per year, and may present more commonly among certain clinical populations.

METHODS

We present 2 cases of self-enucleation in patients with psychotic illnesses and review existing literature on the history of enucleation, associated pathology, and management (both medically and psychiatrically) for this serious form of self-injury.

RESULTS

Literature review includes a brief historical perspective of auto-enucleation and its context in psychosomatic medicine, with cases to highlight key aspects in the prevention and management of ocular self-injury. Normal eye pathology is described briefly, with a focus on medical care after self-inflicted damage, as pertinent to consultation psychiatrists. Interventions for behavioral and pharmacologic management of agitation and impulsivity are reviewed, including consideration for electroconvulsive therapy, in this particular context.

CONCLUSION

Although severe ocular self-injury is uncommon, psychiatrists should be familiar with approaches to prevent and manage auto-enucleation in individuals at risk thereof. Consultation psychiatrists must work closely with ophthalmologists to address affective, behavioral, and cognitive triggers and complications of ocular self-injury.

Bilateral posterior vitreous detachment after electroconvulsive therapy

In this case report, we describe a patient with an acute bilateral posterior detachment of the vitreous, which developed during electroconvulsive therapy (ECT) under general anesthesia. The patient developed symptoms of posterior vitreous detachment immediately after recovery from the eighth ECT session. The ophthalmologist confirmed the clinical diagnosis and ECT was stopped. We review the literature and discuss the ocular side effects of ECT.

Electroconvulsive therapy in the medically ill

The use of electroconvulsive therapy (ECT) in the US continues to expand in the treatment of psychiatric disorders. Electroconvulsive therapy remains the "gold standard" for the treatment of major depression and a variety of other psychiatric and neurologic disorders. Because of the effectiveness and resurgence of ECT, more patients are considered good candidates for this treatment option. Overall, these patients are medication refractory and elderly, and thus more sensitive to polypharmacy. Additionally, these patients tend to have more coexisting medical problems, and often require that a practitioner have solid clinical knowledge of the fields of medicine and psychiatry. This article will review some of the most common comorbid conditions found in patients referred for ECT.

Electroconvulsive therapy in the medically ill

ECT is often a necessary treatment for severe psychiatric disorders in patients with medical or neurologic comorbidity. Although the available data consist largely of cases and case series, ECT is effective in treating psychopathology despite the comorbidity. With appropriate precautions and monitoring during and after ECT, complications can be minimized.