Lance-headed viper (Bothrops moojeni) bite wounding the eye

Abstract

A 5-year-old girl was bitten in her left eye by a lance-headed viper identified as Bothrops moojeni, measuring 115 cm of length. There was severe facial swelling and left exophthalmus, and enucleation of the eye was necessary. The patient apparently had mild systemic envenoming, but local inflammatory signs and histological evidence of necrosis suggest that both the mechanical trauma and the local action of the venom had a role in the genesis of the eye lesion. It is arguable if the loss of the eye could be prevented even if the antivenom was administered earlier.

Bothropssnakebite on the head: case report and review of the literature

“…or Old-World pitvipers (e.g. Deinagkistrodon acutus and Trimeresurus wagleri), are generally severe, resulting in eye injuries (Wolfovitch and Marback, 1988;Brandão et al, 1993;Chen et al, 2005), oedema (Gerkin et al, 1987;Dart and Gustafson, 1991;White and Weber, 1991;Lewis and Portera, 1994;Tanen et al, 2001;Chen et al, 2005;Richardson et al, 2005), compromised airways (Pfeiffer and Price, 1976;Skoda-Tü rk, 1979;Gerkin et al, 1987;Danzl and Carter, 1988;Dart and Gustafson, 1991;Tanen et al, 2001;Brooks et al, 2002;Chen et al, 2005;Richardson et al, 2005), coagulopathy (Dart and Gustafson, 1991;Litovitz et al, 1993;Lewis and Portera, 1994;Quiroga et al, 2000;Otero et al, 2002;Richardson et al, 2005;Warrell, 2004) and, occasionally, death (Willson, 1908;Russell, 1983;Litovitz et al, 1993;Quiroga et al, 2000;Campbell and Lamar, 2004).…”

“…The arboreal Bothriechis schlegelii causes face and neck bites in Chiapas, Mexico (Warrell, 2004), and a fatality following a bite to the tongue by this species has been reported (Campbell and Lamar, 2004). A smaller number of bites involving the head and neck has been associated with terrestrial Bothrops species during normal human activities (Wolfovitch and Marback, 1988;Brandão et al, 1993;Quiroga et al, 2000;Otero et al, 2002). Although most Brazilian Bothrops species are terrestrial, some, including Bothrops atrox (Campbell and Lamar, 1989) and Bothrops jararaca (Sazima, 1988), can occasionally climb shrubs and low-lying branches of trees to a height of 2 m or more.…”

“…In agreement with this finding, only a few detailed case reports involving bites on the head by Brazilian Bothrops spp. have been published (Wolfovitch and Marback, 1988;Brandão et al, 1993) and, in a series of 43 deaths resulting from snakebite in São Paulo state, none was caused by a bite to the head (Ribeiro et al, 1998).…”

Challenges in the management of ocular snake-bite injuries

“…Chemosis, conjunctivitis, corneal oedema and corneal ulceration as a manifestation of snake venom ophthalmia, a condition resulting from the venom ejected from spitting cobras common in Africa, has been reported [8]. Direct inoculation of venom into the eye has been known to cause globe necrosis, keratomalacia and uveitis, often ending up requiring evisceration or enucleation [9,10]. Direct ocular trauma from the bite of a non-venomous Boa constrictor has also been reported [11][12][13].…”

Cyanoacrylate repair of laser in situ keratomileusis corneal flap perforation by a snake bite

“…13 Based on a MEDLINE search dating to 1966, we were able to find 4 reported cases of ocular injuries resulting from snake bites. 1,[14][15][16] Two of these cases involved corneal perforations that were managed with contact lens or suture closure. This case of a snake bite eye injury is unique because the patient had had LASIK and the corneal perforation was treated with cyanoacrylate tissue adhesive.…”