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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 4  |  Page : 213-216

Self - inflicted ocular injuries


Lokmanya Tilak Memorial Medical College, Sion, Bombay, India

Date of Web Publication24-Dec-2007

Correspondence Address:
S N Cooper
Lokmanya Tilak Memorial Medical College, Sion, Bombay
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Cooper S N. Self - inflicted ocular injuries. Indian J Ophthalmol 1968;16:213-6

How to cite this URL:
Cooper S N. Self - inflicted ocular injuries. Indian J Ophthalmol [serial online] 1968 [cited 2020 Aug 9];16:213-6. Available from: http://www.ijo.in/text.asp?1968/16/4/213/37558

The offer to compensate for injuries to the eyes in civil life by Insurance Companies have brought out a new form of injury to the eyes, that of self-inflicted damage to one eye with an idea to make a "quick-rupee" without materially losing the blessing of vision. Three characteristics stand out clearly in such injuries: (1) a tendency to over-insure against the earning capacity of the assured. (2) occurence of the injury soon after paying of the first or perhaps second premium. (3) a cock and bull story complete with witnesses, which somehow does not fit in with the result of one's examination.

A case-record of two such cases are presented to illustrate the match­ing of the cunning of the claimant of such compensation against the wits of the ophthalmologist.

Case I. A case was referred to us nearly six months after an alleged injury, for our expert opinion in the matter. A school-teacher of about 35 years was supposed to have sustained an injury to the eye from a roof-tile that fell directly on his left eye damaging it completely with no per­ception of light. Such a person was seeking compensation for Rs. 100,000 or so and the circumstances under which the compensation was claimed, appeared rather strange to the Company.

(1) His salary as a primary school teacher was not more than Rs. 80/­and his total income about Rs. 135/­per month.

(2) In view of his total income the insurance had been refused to the full amount by one company which was willing to insure him for Rs. 20,000 which he got done, the balance of Rs. 80,000 being made up by another company agreeing to do so.

(3) The accident took place with­in 3 months of paying his first pre­mium.

These circumstances were suspici­ous enough for the company to refer the matter to a specialist.

When first seen by us, the notes of the assured's behaviour, prior to and after the injury were supplied to us.

On the evening of the accident as Mr. T. the assured, was drinking water from a lota, pouring water into his mouth from a distance of about 6 inches, a roof-tile got dislodged by the movement of a pigeon and fell over the left eye, hitting him over the eye from which there was bleeding. A woman attendant was witness to the incident.

Without reporting the matter to anyone at school, he rushed out of the school where a relation arid a friend of his, another Mr. T., happen­ed to be waiting, with whom he rushed to a doctor friend of his, a third Mr. T, Dr. T. The doctor was a semi-qualified person with a regis­trable diploma, who also did some amount of eye-surgery. Two hours later he reported to the civil hospital of the place. What happened during the 2 hour's stay at Dr. T's is not stated, except that the doctor was very busy, could not attend to him immediately and he gave first-aid treatment and applied a bandage. At the hospital, among the injuries that were recorded no abrasion to the skin of the lids, or face had been recorded, not even a black-eye, and the eye did not show any condition urgent enough to merit immediate attention, by someone higher than the house-surgeon. There was, how­ever, no perception of light. The civil ­surgeon, who attended to his eye, two days later, as he was out of town, also did not record any wound or external injury of the face or lids and gave some conservative treatment. After a week he was discharged but re-admitted a couple of days later with an inflamed eye. The inflamma­tion not coming under control, it eventually ended in an atrophied eyeball.

The problems presented for us were:

(1) Was the loss of eyesight due to the alleged injury and nothing but the injury.

(2) The circumstances narrated, did they fit in with the clinical pic­ture, seen three months or more after the injury.

(3) If the loss of eye-sight was not due to the alleged injury how did he happen to lose his eyesight.

With such a back-ground history as was given, it was impossible to har­bour no prejudice, but clinical evi­dence had to be gathered to prove that all was not right in the claim.

I. Vision: There was no percep­tion of light in that eye. Did he have good vision before the injury? There was no record of vision at the time when the policy was taken out. Could the injury reported cause loss of light perception soon after the injury? That would be only possible if there was vitreous haemorrhage or detachment of the retina, for which the injuring body should be smaller than the size of the orbit whereas the injuring body was a roof-tile, almost as big as a brick. It could also be possible if the eyeball was prominent and projecting beyond the line joining the superior orbital mar­gin and the maxillary bone, but the eyeball was of the receding variety. Besides, no abrasions of the lids or skin of the face had been recorded. The conclusion that could be drawn was that the type of injury described could not have caused intraocular haemorrhage or detachment of retina, as a result of which the eye could have lost all vision, immediately after the injury. The eye was probably blind but normal-looking, from some cause previous to the accident.

II. On examination, the eye was found to be an atrophic eye with a puckered horizontal scar about 4 mm. across, right in the center of the cornea. Could such a scar be compa­tible with the history of an injury to the eye with the point of a roof-tile? As stated previously such an injury cannot damage the cornea without injuring the lids, the skin of the face or causing contusion. Even if such an injury did take place, the perfo­ration of the eyeball should have taken place in the sclera concentric with the limbus, about 3 mm. away from it and not in the cornea. There was not the slightest injury to the sclera and certainly no evidence of perforation of the sclera. Again, the type of injury involved and the clini­cal condition were definitely incom­patible.

On examining the cornea with a slit-lamp and microscope, it could be seen that the scar was sharply linear and puckered to which parts of the papillary edge and the lens capsule had become adherent. What could such a scar be due to? It can only be due to a sharp instrument like a cata­ract knife inserted through the center of the cornea damaging the lens. Was there anything in the history of the case to confirm such a possibility? Yes there was circumstantial evidence to that effect. The assured, instead of going straight to the civil hospital; went to a private semi-qualified prac­titioner, who was also doing some kind of eye work. He was engaged with him for 2 hours after which he went to the civil hospital. A clean fresh cut in the cornea can easily be missed especially by an untrained house-surgeon who examined his eyes first. After discharge from the hospital, finding the eye not suffici­ently inflamed, he may have had his eye retampered by the practi­tioner a little more vigorously which may have resulted in a traumatic cataract with a phacolytic inflamma­tion which subsequently became difficult to treat and ended in atro­phy.

An opinion was therefore given:

  1. The ocular condition could not possibly have been due to the type of injury alleged.
  2. The eye was certainly trauma­tised, but not by a blunt instrument, but by a sharp instrument like a cataract knife.
  3. The injury could not have been accidental. It was either self-­inflicted or probably with the aid and connivance of another person or per­sons.
  4. In all probability the eye was blind even before the injury was in­flicted. However, an eye examination was not insisted upon when the party was taken up for insurance against accidents.


The case was compromised with a settlement very much in favour of the company as the assured party, having a guilty conscience, never asked for an appeal against the com­pany's decision.

Case II There was yet another case of a person, who had an insurance taken out against accidents by the same company. His story was that, as he was walking along a New York pavement, somebody gave a shout. On turning rapidly around, some­thing hit his eye, and lie did not know what it was. Most probably, it was the spoke of an umbrella. He attended a hospital there, where-he was treated and asked to return to India.

As I saw it, it was an eyeball un­dergoing atrophy, but there was no sign of perforation. It could have resulted from a vitreous haemorrhage, which the type of injury described could have caused. In this case there was no witness to the accident, no hospital report to confirm his state­ment and a story of an accident, which could be believed with diffi­culty. In this case pressure from an influential level had been exercised and the company was not willing to pursue the matter further. The com­pany wanted to know only if there was even a remote possibility for such an ocular condition to have re­sulted from the type of injury des­cribed, which would enable the com­pany to settle the claim in his favour.

Other opinions have been asked for on similar types of cases, but the re­cords of these two cases show the need for a record of a thorough examination of the eyes before such policies are taken out for accidental insurance, if the sanctity of the in­surance system is to be maintained and not to be ridiculed and abused by unscrupulous persons.

It may be asked, do you think a man will go to the length of getting one eye rendered blind for the sake of a few thousand rupees? In this connection let me tell you the in­stance of a man who wanted a kera­toplasty done to improve the appear­ance of his eye, that had an adherent leucoma. It was in the days when eye-banks were not in operation. The recipient agreed to provide a donor within 24 hours. The next (lay he presented a healthy lad of 19 with 6/5 vision in both eyes, who was willing to sell his eye for a mere Rs. 1,000/-. He said he would have the other eye to work with. Of course, I refused to operate, but when, in India, one is willing to part with a healthy eye at the age of 19, to get one's eye sacrificed at an older age for a larger consideration of money should not come as a surprise.


  Summary Top


The case records of two cases are presented in whom an injury to the eye was probably self-inflicted with a view to collect compensation after taking out a comprehensive insu­rance policy against accidents.

The desirability for a full record of the ocular examination before such a policy is taken out is stressed.




 

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