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

Abstract

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.

Venom Ophthalmia and Ocular Complications Caused by Snake Venom

“…In addition to damage of ocular tissues, acute angle-closure glaucoma (AACG) following snake venom injection was also reported [ 38 , 39 ], in which the anterior chamber fluid circulation is inhibited in the eye leading to intraocular pressure (IOP) increase. A statistical study from India reported that about 50% of snakebite victims developed bilateral AACG one year after the incident [ 40 ]. One patient even developed optic neuropathy one month after AACG diagnosis [ 39 ].…”

A rare case of bilateral tractional retinal detachment following snakebite

“…These include ptosis, external ophthalmoplegia,[ 2 ] conjunctival and corneal lacerations (following direct injury),[ 6 ] subconjunctival hemorrhages,[ 7 ] keratomalacia,[ 5 ] hyphema, anterior uveitis, and angle-closure glaucoma. [ 7 ] Neuro-ophthalmological manifestations such as occipital infarction and optic neuritis have been described. [ 8 ] Posterior segment manifestations, though very rare, have also been reported.…”

“…They include macular infarction, central retinal arterial occlusion,[ 5 ] retinal and subhyaloid hemorrhage,[ 9 ] vitreous hemorrhage,[ 4 ] and exudative retinal detachment. [ 7 ]…”

“…Retinal hemorrhages, infarction, and exudative retinal detachment following snakebite have been reported. [ 5 7 9 ] However, the development of TRD adds a new dimension to the retinal toxicity of snake venom. Hematotoxic snake venoms are known to cause vasculitis.…”

Retraction: Bilateral acute angle closure glaucoma following a snake bite: Are we missing it?

“…It has been reported and found that the article contains overlapping text sections from another article titled, “Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital” previously published in pages 256–262, issue 4, vol. 29 of Korean journal of Ophthalmology[ 2 ]. Therefore, on the grounds of duplicity of text, the article in concern is being retracted.…”