Abstract
Snake bites involving the eye are an uncommon cause of ocular trauma; herein, we present one of the few known instances of a snake bite directly to the globe, specifically by the way of a Coluber constrictor, also known as the “Black Racer.”In this case report, we describe a nine-year-old girl who presented immediately following a snake bite to the right eye. The patient’s vision was unaffected despite visualized puncture wounds through the conjunctiva with associated near-total subconjunctival hemorrhage. The patient was taken to the operating room emergently for globe exploration. Circumferential peritomy and direct view to the sclera did not reveal any lacerations or puncture and subconjunctival vancomycin, gentamycin, and dexamethasone were administered intraoperatively. Post-operatively, the patient was discharged on a regimen of oral Cephalexin. Throughout multiple follow-ups, she continued to maintain excellent vision without sequelae.Trauma to the globe via snake bite is an exceedingly rare occurrence. Upon literature review, three out of three cases involving venomous snakes resulted in “No Light Perception” vision despite anti-venom. While nonvenomous snake bites may lend a better visual outcome, if not treated properly they may also yield poor final visual potential. Methods of treatment include oral or subconjunctival antibiotic administration with or without a steroid or cycloplegic agent. All reported cases of nonvenomous cases ultimately resulted in excellent visual potential (20/40 or better) and no reports of endophthalmitis. As such, it is evident that identifying the species of snake is of the utmost importance when considering visual prognosis. Due to very few reported incidences of globe trauma via snake bite, there is no mainstay therapy for either the venomous or nonvenomous snake bite variety. Despite this, we encourage careful pursuance of the appropriate therapy on a case-by-case basis, considering operative treatment, antivenom (if necessary), and antibiotic coverage with possible cycloplegia and steroid administration.
Highlights
Ocular injuries from snake bites are exceedingly uncommon
Vision-threatening complications after a snake bite are documented, infrequent compared to the number of snake bites worldwide each year
Understanding which category each snake’s venom most closely aligns with can help the physician to treat the patient. These systemic effects related to bites distant from the eyes have been reported in association with multiple diverse ocular complications, including: central retinal artery occlusions [6], uveitis, acute angle-closure [7], extraocular muscle palsies [8,9], optic neuritis, and optic nerve atrophy [10]
Summary
Ocular injuries from snake bites are exceedingly uncommon. While snake bites elsewhere on the body have been known to cause ophthalmic manifestations, snake bites directly to the eye are extremely unusual and rarely reported. With the known history of a Southern Black Racer with needle-like fangs biting the right eye, and the visualized incisions on the lateral eyebrow and conjunctiva (without direct visualization of areas of sclera covered by blood), the decision was made for an examination under anesthesia and exploration of the globe. This was to ensure that an open globe and foreign bodies were not present. The right eye was examined under the operating scope and the site of the conjunctival incisions was again visualized on the nasal bulbar conjunctiva. Complete healing of the conjunctiva and tenon’s capsule was found at a one-month follow-up
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