0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinicopathologic Reports, Case Reports, and Small Case Series |

Self-induced, Bilateral Retinal Detachment in Tourette Syndrome FREE

Sue Lim, MD; Kourous A. Rezai, MD; Gary W. Abrams, MD; Dean Eliott, MD
[+] Author Affiliations

Section Editor: W. Richard Green, MD


Arch Ophthalmol. 2004;122(6):930-931. doi:10.1001/archopht.122.6.930.
Text Size: A A A
Published online

In 1885, the French neurologist Georges Gilles de la Tourette described9 patients with childhood-onset tics accompanied in some by uncontrollablenoises and utterances, as well as hyperactivity and obsessive-compulsive behavior.1 The current diagnosis of Tourette syndrome, accordingto the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-IV), involves multiplemotor tics and at least 1 vocal tic, which occur many times a day, nearlyevery day, or intermittently for more than 1 year. Tics must begin beforeage 18 years.2 The average age of onsetis 7 years, and boys are more commonly affected than girls. Motor tics arecharacterized by involuntary movements such as facial grimacing, frequenteye blinking, blepharospasm, spitting, and arm jerking. Vocal tics often havean aggressive or sexual component, such as grunting, barking, echolalia, andcoprolalia (uncontrolled swearing). The condition often results in deleterioussocial consequences. We report a case of self-induced bilateral retinal detachmentin a young man with Tourette syndrome who was initially referred for monocularhyphema.

A 25-year-old white man was initially seen with a 1-week history offloaters and decreased vision in his left eye. The patient had been diagnosedwith Tourette syndrome at age 7 years, obsessive-compulsive disorder at age11 years, and depression at age 24 years. His motor tics involved excessiveblinking, blepharospasm, clapping, jabbing his fingers into his eyes, andpunching himself in the periorbital area. The patient was taking buspironehydrochloride (10 mg twice a day) and clomipramine hydrochloride (25 mg twicea day). On examination, the patient was alert and oriented, and he had noevidence of cognitive impairment. Visual acuity was 20/200 OD and hand motionOS. There was no afferent pupillary defect. Intraocular pressures were 18OD and 16 OS. Slitlamp examination findings of the right eye demonstratedpigment deposits on the corneal endothelium, moderate (2+) aqueous pigmentedcells, and posterior subcapsular cataract. The left eye had a less than 1-mmhyphema and many (4+) circulating red blood cells in the anterior chamber,as well as a dense posterior subcapsular cataract. Funduscopy results revealeda retinal dialysis from the 1:30 to the 4:30 clock position with a macula-on-retinaldetachment in the right eye. Vitreous hemorrhage was present centrally inthe left eye, and there were nasal and temporal giant retinal tears. The righteye was repaired with a scleral buckling procedure. The left eye underwentanterior segment washout, pars plana lensectomy, pars plana vitrectomy, endolaser,and silicone oil injection. Intraoperatively, the giant retinal tears werefound to extend from the 12:30 to the 4:30 clock position with 4 long radialextensions to the temporal macula and from the 6-o'clock to the 11-o'clockposition with 1 long radial extension to the optic disc. There was an additionalradially oriented posterior retinal break. Postoperatively, the retinas wereattached in both eyes. One month later, the left eye developed proliferativevitreoretinopathy with retinal detachment and underwent reoperation. At 6months, the retinas remained attached and the visual acuity was 20/100 OU.

Ophthalmic manifestations of Tourette syndrome include frequent blinkingand blepharospasm, gaze deviations and abnormal saccades, and accidental andself-inflicted ocular injuries.35 Theretinal detachments in our patient were most likely the result of repeated,self-induced finger jabbing to the eyes since the patient had no other riskfactors for retinal detachment. In patients with retinal detachment, factorssuggesting a traumatic etiology typically include unilateral vitreoretinalfindings, retinal dialysis or giant retinal tear, and age younger than 40years.6,7 However, in patientswith self-induced or repeated trauma, the vitreoretinal pathologic featuresmay be bilateral, as demonstrated by our patient. To prevent further self-injury,patients should wear protective polycarbonate goggles, and they should bemonitored closely in conjunction with the psychiatry service. Treatment ofthe underlying disorder with behavior modification and pharmacotherapy isessential, and pharmacological agents that antagonize dopamine are most effectivein reducing the severity of motor and vocal tics.

The authors have no relevant financial interest in this article.

Corresponding author: Dean Eliott, MD, Kresge Eye Institute, WayneState University School of Medicine, 4717 St Antoine, Detroit, MI (e-mail: deliott@med.wayne.edu).

Jankovic  J Tourette's syndrome. N Engl J Med. 2001;3451184- 1192
PubMed Link to Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition.  Washington, DC American Psychiatric Association1994;100- 105
Tatlipinar  SSener  ECIlhan  BSemerci  B Ophthalmic manifestations of Gilles de la Tourette syndrome. Eur J Ophthalmol. 2001;11223- 226
PubMed
Margo  CE Tourette syndrome and iatrogenic eye injury. Am J Ophthalmol. 2002;134784- 785
PubMed Link to Article
Robertson  MMTrimble  MRLees  AJ Self-injurious behaviour and the Gilles de la Tourette syndrome: aclinical study and review of literature. Psychol Med. 1989;19611- 615
PubMed Link to Article
Goffstein  RBurton  TC Differentiating traumatic from nontraumatic retinal detachment. Ophthalmology. 1982;89361- 368
PubMed Link to Article
Eliott  DAvery  RL Nonpenetrating posterior segment trauma. Ophthalmol Clin North Am. 1995;8647- 666

Figures

Tables

References

Jankovic  J Tourette's syndrome. N Engl J Med. 2001;3451184- 1192
PubMed Link to Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition.  Washington, DC American Psychiatric Association1994;100- 105
Tatlipinar  SSener  ECIlhan  BSemerci  B Ophthalmic manifestations of Gilles de la Tourette syndrome. Eur J Ophthalmol. 2001;11223- 226
PubMed
Margo  CE Tourette syndrome and iatrogenic eye injury. Am J Ophthalmol. 2002;134784- 785
PubMed Link to Article
Robertson  MMTrimble  MRLees  AJ Self-injurious behaviour and the Gilles de la Tourette syndrome: aclinical study and review of literature. Psychol Med. 1989;19611- 615
PubMed Link to Article
Goffstein  RBurton  TC Differentiating traumatic from nontraumatic retinal detachment. Ophthalmology. 1982;89361- 368
PubMed Link to Article
Eliott  DAvery  RL Nonpenetrating posterior segment trauma. Ophthalmol Clin North Am. 1995;8647- 666

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 4

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles