Challenges in the management of ocular snake-bite injuries

Abstract

Ocular snake-bite injuries are quite rare away from natural habitats. However, when exotic animals are kept in captivity, the injuries sustained and their management can pose challenges when they present to their local eye department. This report describes an atypical eye injury inflicted by a python and its successful management involving surgical, laser and medical interventions. The case highlights the possible pitfalls resulting from the unusual mechanism of injury and the steps to avoid them. The article goes on to discuss the background of the injuries that can be caused by venomous and non-venomous snakes.

A Guide to Direct (Peri)ocular Injuries Caused by Snakes: Systematic Review and Treatment Advice

“…Another python-related injury was reported from the UK, where a 26-year-old male snakekeeper in a safari park was attacked by a 4.5-m-long Indian rock python (Python molurus), resulting in a full-thickness corneoscleral laceration with shallow anterior chamber and hyphema, which was closed under general anesthesia using nylon sutures. 17 Fundoscopy after 2 days showed a retinal tear without subretinal fluid, just anterior to the equator, which was successfully treated with argon laser.…”

“…Seven reports of patients bitten by a nonvenomous snake were retrieved (Table 2). 7,8,[13][14][15][16][17] One young patient was bitten by a wild colubrid. The other six pertained to snakes held in captivity, and all involved a corneal perforation.…”

“…Fundoscopy should be performed as soon as permitted to check for (additional) retinal defects. 17 In cases of scleral perforation with expulsion of intraocular contents and poor visual prognosis, evisceration or enucleation to prevent sympathetic ophthalmia should be considered within 2 weeks. 11,27 Treatment of direct inoculation with snake venom.…”

A Guide to Direct (Peri)ocular Injuries Caused by Snakes: Systematic Review and Treatment Advice

“…Another python-related injury was reported from the UK, where a 26-year-old male snakekeeper in a safari park was attacked by a 4.5-m-long Indian rock python (Python molurus), resulting in a full-thickness corneoscleral laceration with shallow anterior chamber and hyphema, which was closed under general anesthesia using nylon sutures. 17 Fundoscopy after 2 days showed a retinal tear without subretinal fluid, just anterior to the equator, which was successfully treated with argon laser.…”

“…Seven reports of patients bitten by a nonvenomous snake were retrieved (Table 2). 7,8,[13][14][15][16][17] One young patient was bitten by a wild colubrid. The other six pertained to snakes held in captivity, and all involved a corneal perforation.…”

“…Fundoscopy should be performed as soon as permitted to check for (additional) retinal defects. 17 In cases of scleral perforation with expulsion of intraocular contents and poor visual prognosis, evisceration or enucleation to prevent sympathetic ophthalmia should be considered within 2 weeks. 11,27 Treatment of direct inoculation with snake venom.…”

Coluber Constrictor Bite to the Eye: A Novel Case Report of a Wild Snake Bite to the Eye in North America and Review of Literature

“…Standard of care for nonvenomous site bites elsewhere on the body does not include empiric antibiotics to prevent secondary infections after snakebites, although tetanus prophylaxis should be provided as needed. Of those with reported drug selections (five cases) [1][2][3][14][15], each patient received treatment with a topical fluoroquinolone, although the specific drug of choice varied. Kleinman et al discussed the likelihood of bacterial stomatitis, especially in captive snakes, as a reason for antibacterial therapy in ocular snakebite injuries and found that in the pet Boa constrictor case, cultures from the teeth of the snake showed multiple species of Gram-negative rods [3].…”

“…Other medications were also utilized. Three cases (50%) received a topical steroid [1,12,15], one case received subconjunctival antibiotics intraoperatively [2], and two cases (33%) received a topical cycloplegic [1,14]. Despite venomous snake bites to the eye having a poor visual prognosis, each of the nonvenomous cases ultimately ended with a bestcorrected visual acuity of better than 20/40.…”

A Guide to Direct (Peri)ocular Injuries Caused by Snakes: Systematic Review and Treatment Advice

“…Another python-related injury was reported from the UK, where a 26-year-old male snakekeeper in a safari park was attacked by a 4.5-m-long Indian rock python (Python molurus), resulting in a full-thickness corneoscleral laceration with shallow anterior chamber and hyphema, which was closed under general anesthesia using nylon sutures. 17 Fundoscopy after 2 days showed a retinal tear without subretinal fluid, just anterior to the equator, which was successfully treated with argon laser.…”

“…Seven reports of patients bitten by a nonvenomous snake were retrieved (Table 2). 7,8,[13][14][15][16][17] One young patient was bitten by a wild colubrid. The other six pertained to snakes held in captivity, and all involved a corneal perforation.…”

“…Fundoscopy should be performed as soon as permitted to check for (additional) retinal defects. 17 In cases of scleral perforation with expulsion of intraocular contents and poor visual prognosis, evisceration or enucleation to prevent sympathetic ophthalmia should be considered within 2 weeks. 11,27 Treatment of direct inoculation with snake venom.…”

Coluber Constrictor Bite to the Eye: A Novel Case Report of a Wild Snake Bite to the Eye in North America and Review of Literature

“…Standard of care for nonvenomous site bites elsewhere on the body does not include empiric antibiotics to prevent secondary infections after snakebites, although tetanus prophylaxis should be provided as needed. Of those with reported drug selections (five cases) [1][2][3][14][15], each patient received treatment with a topical fluoroquinolone, although the specific drug of choice varied. Kleinman et al discussed the likelihood of bacterial stomatitis, especially in captive snakes, as a reason for antibacterial therapy in ocular snakebite injuries and found that in the pet Boa constrictor case, cultures from the teeth of the snake showed multiple species of Gram-negative rods [3].…”

“…Other medications were also utilized. Three cases (50%) received a topical steroid [1,12,15], one case received subconjunctival antibiotics intraoperatively [2], and two cases (33%) received a topical cycloplegic [1,14]. Despite venomous snake bites to the eye having a poor visual prognosis, each of the nonvenomous cases ultimately ended with a bestcorrected visual acuity of better than 20/40.…”

A Guide to Direct (Peri)ocular Injuries Caused by Snakes: Systematic Review and Treatment Advice

“…Another python-related injury was reported from the UK, where a 26-year-old male snakekeeper in a safari park was attacked by a 4.5-m-long Indian rock python (Python molurus), resulting in a full-thickness corneoscleral laceration with shallow anterior chamber and hyphema, which was closed under general anesthesia using nylon sutures. 17 Fundoscopy after 2 days showed a retinal tear without subretinal fluid, just anterior to the equator, which was successfully treated with argon laser.…”

“…Seven reports of patients bitten by a nonvenomous snake were retrieved (Table 2). 7,8,[13][14][15][16][17] One young patient was bitten by a wild colubrid. The other six pertained to snakes held in captivity, and all involved a corneal perforation.…”

“…Fundoscopy should be performed as soon as permitted to check for (additional) retinal defects. 17 In cases of scleral perforation with expulsion of intraocular contents and poor visual prognosis, evisceration or enucleation to prevent sympathetic ophthalmia should be considered within 2 weeks. 11,27 Treatment of direct inoculation with snake venom.…”

Coluber Constrictor Bite to the Eye: A Novel Case Report of a Wild Snake Bite to the Eye in North America and Review of Literature

“…Standard of care for nonvenomous site bites elsewhere on the body does not include empiric antibiotics to prevent secondary infections after snakebites, although tetanus prophylaxis should be provided as needed. Of those with reported drug selections (five cases) [1][2][3][14][15], each patient received treatment with a topical fluoroquinolone, although the specific drug of choice varied. Kleinman et al discussed the likelihood of bacterial stomatitis, especially in captive snakes, as a reason for antibacterial therapy in ocular snakebite injuries and found that in the pet Boa constrictor case, cultures from the teeth of the snake showed multiple species of Gram-negative rods [3].…”

“…Other medications were also utilized. Three cases (50%) received a topical steroid [1,12,15], one case received subconjunctival antibiotics intraoperatively [2], and two cases (33%) received a topical cycloplegic [1,14]. Despite venomous snake bites to the eye having a poor visual prognosis, each of the nonvenomous cases ultimately ended with a bestcorrected visual acuity of better than 20/40.…”