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Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 55-57

Ocular nonsuicidal self-injury in a teenager

1 Department of Pediatrics, Pediatric Ocular Immunology Unit, University of Padova, Padova, Italy
2 Department of Pediatrics, Pediatric Neuropsychology Unit, University of Padova, Padova, Italy
3 Department of Pediatrics, Pediatric Rheumatology Unit, University of Padua, Padova, Italy

Correspondence Address:
Maria Elisabetta Zannin
Department of Pediatrics, Via Giustiniani, 3, 35128 Padova
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.OJO_209_2016

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A 14-year-old male teen presented with unilateral episcleritis, unresponsive to topical and systemic corticosteroid therapy, without a history of ocular trauma or evidence for systemic diseases. The presence of foreign bodies in the conjunctival mucus of the hyperemic fornix has been noticed during one of the follow-up examinations. The toxicological analysis of conjunctival mucus revealed the presence of ethylene glycolmonomethyl ether and triethilene glicolebuthyl ether, used as solvents in nail polish removers and all-purpose cleaners. An unexpected etiology of chemical self-inflicted episcleritis was determined. The teen was admitted to a psychological assessment, after which a psychotherapeutic treatment was recommended. Episcleritis is characterized by the acute onset of ocular pain and redness, with a frequent recurrent and stressful course. Since it can be associated with life-threatening systemic vasculitides, a prompt, aggressive immunosuppressive therapy may be considered, both for the ocular inflammation and for the underlying systemic condition. Rarely episcleritis does not improve despite topical and systemic therapy, administered in a stepladder way. The reported teenager case needed a complex multidisciplinary approach to achieve the correct diagnosis and to avoid unnecessary treatments. In the case of recognized “nonsuicidal self-injury,” a psychological evaluation is strongly recommended, to identify and address underlying neuropsychiatric problems.

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