Severe Bilateral Ocular Chemical injury after use of Traditional Medicines: Result of Malpractice in Indian Villages

Abstract

Case History A 24 year old farmer presented with bilateral decreased vision of three days duration. There was a history of snake bite on his left arm after which he was taken to a snake charmer at his village for treatment. A traditional eye medicine in the form of a whitish flaky powder was instilled into both his eyes by the snake charmer to keep him “awake”. Two days later he developed pain, redness and reduced vision in both eyes. He was referred to a tertiary care hospital. At presentation the visual acuity in both the eyes was perception of light. There was lid edema and conjunctival necrosis with 360 degree limbal involvement in both eyes. Examination of the right eye revealed the presence of corneal melt with iris prolapse and adhesions at multiple sites between bulbar and palpebral conjunctiva (Figure 1A). The left eye cornea was edematous with large epithelial defect (Figure 1 B). Blood coagulation profile, renal and liver function tests were normal. Prothrombin time was 11 seconds, Partial thromboplastin time 40 seconds,blood urea 24 mg%, creatinine 0.6 mg%, total bilirubin 0.9 mg%, SGOT 10 units/ litre, SGPT 13 units/litre. Topical 5% cefazolin and 0.5% carboxymethyl cellulose (CMC) eye drops were started at hourly intervals. Homatropine hydrobromide 2% and autologous serum 20% eye drops were started four times a day for both eyes. The patient underwent large diameter tectonic keratoplasty in the right eye (Figure 2a & b) with bilateral amniotic membrane transplantation (Figure 3a & b). Postoperatively the patient was advised topical 0.5% CMC and 0.3% gatifloxacin for both eyes. Subsequently,he was started on 0.5% loteprednol and a permanent tarsorrhaphy was performed in the right eye to salvage the graft. At 12 weeks follow up the patient had visual acuity of 6/24 with partially opaque cornea in the left eye (Figure 4 a). Right eye had visual acuity of light perception only with opaque corneal graft (Figure 4 b). Chemical analysis of the powder obtained from the snake charmer revealed it to be potassium nitrite. Figure 1 (a): Right eye on presentation: corneal melt with iris prolapse