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Make your diagnosis in the comments, and look for the answer in next month’s Blink.

Last Month’s Blink

Self-Harm During the Pandemic

Written by Victor D. Liou, MD, and Nahyoung G. Lee, MD. Photos by Dr. Lee. Both are at Massachusetts Eye and Ear, Boston.

A 40-year-old engineer on dulox­etine for depression presented for evaluation of persistent left upper eyelid chalazion (Fig. 1). During the COVID-19 pandemic, she self-managed her chalazion by using sharp forceps to etch out her meibo­mian glands and denude any granu­lation tissue, which she believed were painful meibomian stones. She reported that although the act of picking at the eyelid was painful, it resulted in temporary but significant relief of the constant foreign body sensation.

Examination revealed eyelid retraction, madarosis, and effacement of the margin and meibomian gland structures with a full-thickness tarsal cleft (Fig. 2). Use of a scleral bandage contact lens broke her obsessive-compulsive cycle, allowing her eyelid to heal.

Ophthalmologists should have a heightened awareness for self-inflicted injury triggered by quarantine and isolation, especially in patients with preexisting psychiatric diagnoses. Detailed history taking continues to be of utmost importance, and comanagement with psychiatry should be considered in difficult cases.

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