Snake Venom Conjunctivitis

Abstract

THE relative mildness of this case is thought to be of interest.Case Report A Mandinka adult male was clearing scrub in a garden near Bathurst, Gambia, when he felt a spray over the left side of his face and left eye while bending down. This had come from a snake about three feet away from him, which then disappeared; from the description it seemed to be a cobra of the species Naja (Naja nigricollis).The man immediately attended at a clinic and was examined about half an hour after the incident. He did not appear to be in any great discomfort, but the left eye was injected. The conjunctival vessels were prominent in the palpebral fissure but appeared to be normal beneath the upper lid. There were a few small haemorrhagic areas on the outer side but these may have resulted from rubbing the eye. The cornea appeared clear macroscopically but slit-lamp examination showed an appearance of nummular " muttonfat" superficial punctate keratitis. Treatment consisted of irrigation, the instillation of a few drops of decicaine, and the application of penicillin-streptomycin ointment.Contrary to expectation, the next morning the eye appeared almost normal and no further treatment was given. DiscussionIn contrast with the case reported by Ridley (1944), the signs and symptoms were extremely mild. It might be thought that this was because only a small quantity of venom entered the eye, or because it was well diluted.However, on inquiry, it appears that this type of accident is by no means uncommon in the Gambia, especially at certain seasons, and is regarded with slight concern by the population. The after-effects are minimal and systemic effects are rare. Where these have occurred they are attributed to absorption through cuts in the face (e.g. after shaving).The corneal lesions were not unlike those seen after the instillation of detergents or Cetavlon in excessive strength into the eye, and this is consistent with what is known of the composition of cobra venom.The question of how the snake spits raises problems which have been fully discussed by Ridley. It would seem that the range of attack has usually been considerably over,estimated. Careful questioning elicits the information that the victim is nearly always bending down when the face is *

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

“…[ 1 2 ] Ocular manifestations of snake bite reported in literature range from direct injury to the eye leading to penetrating injuries with bite marks, conjunctival and corneal lacerations, subconjunctival hemorrhage, keratomalacia, hyphema, uveitis, acute angle closure glaucoma (ACG), optic neuritis, external ophthalmoplegia, vitreous hemorrhage, and endophthalmitis resulting in blindness. [ 3 4 5 6 7 ] A thorough review of literature shows isolated case reports describing ACG following a snake bite. [ 8 9 ] We report a case series of acute ACG following snake bite, their clinical characteristics, management, and outcomes observed over 1 year in a tertiary care center in India.…”

Challenges in the management of ocular snake-bite injuries

“…Vitreous haemorrhage, macular infarction and central retinal artery occlusion can occur as a result of haemotoxicity [5][6][7]. 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].…”

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

“…This is in contrast to other studies from India where neurotoxic snake bite was reported to be the most common followed by viper bite [ 4 5 ]. Various ocular manifestations of snake bite described in the literature are bilateral angle closure glaucoma, chemical injury to the eye from spitting of highly irritant snake venom [ 6 7 ], direct injury to the eye leading to penetrating injuries with bite marks, conjunctival and corneal lacerations [ 8 ]. Subconjunctival hemorrhages and hyphema due to the systemic hematotoxicity, keratomalacia due to collagenase in the snake venom causing stromal lysis, uveitis as a result of serum sickness-like response occurring due to ASV or direct toxicity of venom in penetrating injuries and endophthalmitis have also been reported [ 9 10 11 ].…”