Visual diagnosis: Enucleation status post gunshot wound to the head: A visual diagnosis/case report

Patients that attempt suicide are common in the Emergency Department. Suicidal gestures such as intentional medication or illicit drug overdose and attempted laceration of arteries are frequently seen. True intent to commit suicide includes gunshot wounds to the head. These typically are non-survivable injuries, but there occasionally are those that survive these injuries, and we present such a case.A 55-year-old male presented to our Emergency Department after reportedly shooting himself through the left temple with a.22 caliber handgun in a purported attempt to commit suicide. Per report, the patient was found in his house by a friend, but was easily arousable with intact mentation approximately 20 h after the event allegedly occurred. Upon arrival he reported only moderate facial pain and complete absence of vision, including light and shadow. He denied dizziness, lightheadedness, or confusion.In the Emergency Department, the patient's vital signs were temperature 37.2 °C, pulse 82 beats per minute, respiratory rate of 20 per minute, and blood pressure 126/60 mmHg. His airway was patent with bilateral breath sounds that were clear, and he had unlabored breathing. He had equal pulses present and strong bilaterally, with regular rate and rhythm on cardiac exam. His abdomen was non-tender and non-distended.He had extensive bandaging placed by EMS, and after it was removed from around the wound area, his HEENT exam revealed the patient had extensive bilateral periorbital edema with severe ecchymosis, with desiccated tissue remnants of the right globe protruding from the orbital socket. The left globe was complete eviscerated. There was profound edema of the mid-face, but surprising stability of this region on exam. There was a through-and-through wound entering at the left temple, 1 cm in diameter, with a right temple exit wound about 2 cm in diameter, with tissue avulsion. The nasal bridge was intact, without blood in the nares. The tympanic membranes were intact bi