Self-inflicted Bilateral Ocular Perforation in an Adolescent Patient with Major Depressive Disorder and Borderline Personality Traits

Background: Self-inflicted eye injuries are not common but constitute one of the main forms of non-suicidal self-injuries (NSSI). They can be seen in a variety of psychiatric conditions. Method: This article presents a case report of a 14 year old female patient with major depressive disorder, features of borderline personality disorder, and a history of trauma. We review the literature on self-inflicted eye injuries and non-suicidal self-injury and discuss the relevance to this case. Summary: The patient sustained bilateral self-inflicted ocular perforation with leakage of vitreous humor. She denied any intention to commit suicide and had no clear immediate precipitant triggering the incident. The patient was hospitalized with a plan to transfer to a residential treatment center for intensive dialectical behavioral therapy (DBT). Discussion: The case discussed here appears to fit best into the impulsive NSSI category of the medical descriptive model. The first line treatment for this condition is psychotherapy. Several psychodynamic and biochemical theories have been proposed to describe the mechanism of this psychopathology; however, none have been conclusive.