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The purpose of the present paper was to describe the circumstances and phenomenology of patients who remove or pierce their eyes or orbits during psychotic illness. In particular, the aim was to determine if patients in their first-episode psychosis (FEP) carry an increased risk of self-inflicted eye injury when compared to patients with previously treated psychosis (PTP). Data were extracted from all of the case reports published in English since 1960 and from two unpublished Australian cases. More than half of the cases of self-inflicted eye injury that resulted in permanent loss of vision occurred during FEP. Serious self-inflicted eye injuries are rare, but the risk appears to be greatest during FEP. Earlier treatment of emerging psychosis and close attention to patients who attempt to injure their eyes may occasionally prevent blindness.