PurposeOcular 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.MethodsThis 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.ResultsTwelve 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%).ConclusionsBilateral 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.

ObjectiveTo identify the effects of chronic alcohol and/or tobacco use on retinal nerve fibre layer (RNFL) thickness and to find the association between severity of addiction with RNFL thinning.MethodologyA case–control study was performed in 200 eyes of cases and 200 healthy control eyes. Cases were recruited from deaddiction clinic having history of alcohol and/or tobacco use for at least 5 years. Severity of alcohol and tobacco was graded by Alcohol Use Disorders Identification Test (AUDIT) and Fagerstorm Nicotine Dependence (FTND) scale, respectively. Age-matched and gender-matched individuals attending ophthalmology outpatient department without addiction were recruited as controls. RNFL thickness was measured using Stratus optical coherence tomography (OCT).ResultsStatistically significant RNFL thinning was noted in all quadrants except nasal quadrant in the cases. Statistically significant thinning was seen in all quadrants except nasal with increased FTND scale. Thinning was noted in all quadrants with higher AUDIT scale, but this was statistically not significant.ConclusionChronic alcohol and tobacco use are likely to cause RNFL thinning. OCT can be used as a screening tool to suspect visual morbidities in chronic tobacco and alcohol users.

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The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.

Aims: In this study, we aimed to assess the link between visual evoked potentials (VEP), angiogenic marker (VEGF) and autonomic function tests in type-2 diabetes mellitus (T2DM). Methods: Age-matched 86 male subjects (44 type-2 diabetics on treatment and 42 normal healthy volunteers) were recruited for this study. Body mass index (BMI), basal cardiovascular parameters, spectral analysis of heart rate variability (HRV), were assessed. Fasting blood glucose, insulin, HOMA-IR and VEGF were estimated. The independent association of the P100 latency of VEP with VEGF was determined by multiple regression analysis. Results: LF-HF ratio a marker of sympathovagal balance, increased significantly (p=0.0287) in diabetic group compared to the control group. Comparison of visual evoked potentials between controls and diabetic groups showed significant increase in latency of P100 of both the eyes (right eye p<0.0001, left eye p=0.0003) among the cases. There was significant increase (p=0.0091) in VEGF in diabetic subjects when compared to control. Also positive and significant correlation of P100 latency of VEP with VEGF is seen in diabetics. Conclusions: There is delayed latency of VEP and increased VEGF in type 2 diabetic people. The correlation between VEP and VEGF could indicate the probable role of angiogenesis leading to reduced integrity of the neural pathways in T2DM.