Self-inflicted penetrating orbital trauma is a rare ophthalmologic emergency requiring timely intervention and neurological monitoring to identify and treat any possible intracranial complications and to prevent irreversible vision loss. This case report aims to describe a fatal case of self-inflicted ocular trauma following the consumption of psilocybin mushrooms, necessitating urgent multidisciplinary care by the ophthalmology and neurosurgery services.

A 21-year-old Hispanic male presented urgently to the emergency department (ED) after self-inflicted ocular trauma with a wood-cased pencil, which was embedded in the upper eyelid and transversed the left orbit, extending to the pons, as depicted on computed tomography (CT). Physical examination of the left eye was difficult due to the risk of displacement of the pencil within the brainstem and concern for further damage. The pencil was successfully removed via fluoroscopy-guided neuro-interventional catheterization and stenting. Following the removal of the foreign body, there was no apparent damage to the globe, and a canthotomy/cantholysis was performed due to increased retro-orbital pressure. The neurovascular damage sustained by the trauma led to a progressive neurological decline in the following days and, ultimately, a fatal outcome.

With growing support in the literature for psilocybin and its therapeutic medicinal benefits for conditions such as depression and anxiety, this report details a case of self-inflicted trans-orbital trauma with brainstem injury following ingestion of this psychoactive hallucinogen along with the proper medical and surgical management.