Abstract
Snake envenomation is a major public health problem of the Savannah regions of West Africa. Ocular manifestations of snakebites are rare with few reports documenting blindness as a complication. To highlight an unusual manifestation of snake bites and its attendant problems. A report of scalp haematoma and blindness in a 10 year old child presenting 2 weeks after a snake bite (presumably carpet viper) is a rare manifestation. Local swelling, epistaxis, bilateral proptosis, exposure keratopathy and use of traditional eye medications were associated findings. Anti-venom though administered late saved the child's life but blindness could not be reversed. Ocular ultrasonography revealed layered retrobulbar collection in the left eye, presumably due to hemorrhage. The skull x-ray showed a soft tissue swelling and aspirate from scalp swelling was bloody. Cranial Computed Tomography (CT) scan done late detected no abnormalities. Snakebite is associated with lifelong morbidity. Ocular manifestations must be treated as emergency. This case highlights the effect of ignorance and poverty in a setting of a common medical emergency leading to blindness and reduced quality of life.
Highlights
Snake envenomation is a major public health problem of the Savannah regions of West Africa
We report a case of bilateral blindness in a 10 year old boy following a viper bite and to the authors’ knowledge, the first in Southern Nigeria
Case report A 10 year old boy from a rural community in South west, Nigeria presented at the Emergency Paediatric unit with a 2 week history of swelling of the left middle finger following a bite by a brownish snake
Summary
Snake envenomation is a major public health problem of the Savannah regions of West Africa. Case report A 10 year old boy from a rural community in South west, Nigeria presented at the Emergency Paediatric unit with a 2 week history of swelling of the left middle finger following a bite by a brownish snake. The left middle finger was hyperpigmented and necrotic with neither loss of sensation nor limitation of movement (Fig. 2) Visual acuity in both eyes was no perception of light, and bilateral non-axial proptosis, worse on the left ( RE 26mm, LE 28 mm ) with severe conjunctival chemosis. There was corneal haziness bilaterally from exposure keratopathy and possibly traditional eye medications with no view of further details He had bilateral lid oedema with complete ophthalmoplegia. There was gradual reduction in the scalp swelling and proptosis, but minimal improvement in the eye sight with bilateral corneal opacities (Fig 3).
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