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.

Venom Ophthalmia and Ocular Complications Caused by Snake Venom

“…Another 5-year-old female patient suffered from snake venom injection directly to her eye, leading to eye enucleation due to sever ocular necrosis [ 47 ]. However, another victim was bitten by Python molurus (non-venomous) to his left eye, causing corneo-scleral laceration and hyphaema [ 48 ]. After appropriate treatments, including Argon laser retinopexy, he was discharged after one week.…”

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.…”

Canine ocular and periocular snakebites requiring enucleation: A report of 19 cases

“…Case reports of penetrating ocular injuries with direct intraocular injection of venom from a snakebite resulted in extensive intraocular hemorrhage and necrosis requiring either enucleation or evisceration . On the other hand, those who experienced penetrating ocular injuries from nonvenomous snakebites had uneventful vision recovery after surgical repair of the corneal or scleral defect …”

“…6,7 On the other hand, those who experienced penetrating ocular injuries from nonvenomous snakebites had uneventful vision recovery after surgical repair of the corneal or scleral defect. [8][9][10] In canine patients, despite the common occurrence of snakebite injuries to the face, ocular and periocular involvement is rarely reported. A retrospective review by Martin et al 11 described ophthalmic abnormalities secondary to nine periocular and two ocular snakebites in dogs.…”