Korean J Ophthalmol.  2015 Aug;29(4):256-262. 10.3341/kjo.2015.29.4.256.

Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital

• Praveen Kumar KV
• Praveen Kumar S
• Kasturi N
• Ahuja S

• KMID: 2363770
• DOI: http://doi.org/10.3341/kjo.2015.29.4.256

Abstract

PURPOSE
Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center.
METHODS
This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes.
RESULTS
Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%).
CONCLUSIONS
Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

Keyword

Ocular manifestations; Snake bites; Venoms

MeSH Terms

Acute Disease
Adolescent
Adult
Animals
Antivenins/therapeutic use
*Elapidae
Female
Follow-Up Studies
Glaucoma, Angle-Closure/diagnosis/*etiology/therapy
Humans
Male
Middle Aged
Ophthalmoplegia/diagnosis/*etiology/therapy
Prospective Studies
Snake Bites/*complications/diagnosis/therapy
Snake Venoms/*poisoning
Tertiary Healthcare
Time Factors
Uveitis, Anterior/diagnosis/*etiology/therapy
*Viperidae
Young Adult
Antivenins
Snake Venoms

Figure

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  Fig. 1 Clinical photograph of case 1 showing subconjunctival hemorrhage in both eyes.

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  Fig. 2 Anterior segment photographs of case 9 showing acute anterior uveitis.

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  Fig. 3 Anterior segment photographs of case 9 showing posterior synechiae.

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  Fig. 4 Fundus photograph of case 9 showing hyperemia and edema of the optic disc in right eyes.

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  Fig. 5 Fundus photograph of case 9 showing hyperemia and edema of the optic disc in left eyes.

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  Fig. 6 Clinical photograph showing bilateral severe ptosis with squint.

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  Fig. 7 Clinical photograph showing marked limitation of extraocular motility.

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