|Year : 1975 | Volume
| Issue : 3 | Page : 35-36
SC Gupta, MS Vyas
Sardar Patel Medical College and Associated Group of Hospitals, Bikaner, India
S C Gupta
Sardar Patel Medical College and Associated Group of Hospitals, Bikaner
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta S C, Vyas M S. Snake bite. Indian J Ophthalmol 1975;23:35-6
Though world mortality from snake bite is estimated as 20,000 to 25,000 annually, yet not many cases have been reported in the literature regarding the ocular findings. Due to rarity of the eye involvement and because no case has been reported from India, this case is being presented.
| Case Report|| |
A thirty year old Hindu male (S.K.) was admitted in the hospital with the complaint of bleeding from right toe (big) after the snake bite of three days duration and convulsions for the last two days. Three days back when the patient was going for a nature's call in the fields at about 8 00 P.M., the snake bit his right toe (big) suddenly. On reaching home he noticed blood oozing from the above site. It was followed by intense headache and oedema of the leg. Patient remained unconscious for about 1½ hours. Some indigenious treatment was given which resulted in diarrhoea and vomiting. On the third day, the patient again fell unconscious. After having been treated by a private practitioner, he was admitted in the hospital.
At the time of admission, the general examination revealed the pulse rate to be 64 beats per minute, BP 150/90 mm Hg. Patient was conscious with sluggish and incoherent speech. There was marked neck rigidity and convulsions. There were no signs of localization.
Eye examination revealed pupils to be normal. There was left exotropia of about 25° with limitation of adduction, and nystagmus on dextroversion, Diplopia was present. A linear conjunctival haemorrhage was present on the temporal site. Papilloedema of about 2.00 D was present in both the eyes associated with haemorrhages. Modullated nerve fibres were also present above and below the disc in the left eye.
Investigations revealed - urine to be full of R.B.C.'s, bleeding time 5 minutes, coagulation time 6 minutes. Lumber puncture was not done as the patient had all the signs and symptoms of subarachnoid haemorrhage alongwith papilloedema. He was treated with anti-snake venom, coramine injection, coagulants corticoids and antibiotics. He showed remarkable improvement in a weeks time.
| Discussion|| |
There are about 2,500 species of snakes in the world, of which about 300 are poisonous. The amount of venom and its toxicity are subject to wide variation. Numerous enzymes have been identified in snake venom. Hyaluronidase present in most venoms account for the rapidity of absorption. Proteases cause local inflammation, necrosis and damage to vascular epithelium. Phospholipase alters membrane permeability and releases histamine, thus contributing to haemorrhage and shock. Phosphodiasterase is responsible for its hypotensive effects. Esterases in some viper venoms. liberate bradykinim. By and large snake venoms produce three groups of toxic effects(a) Neurotoxic (b) Haemolytic and Haemorrhagic (c) Necrotising. Shock produced is partly by fright and partly by severe haemolysis and haemorrhage.
Cobra venom is mainly neurotoxic while vipers are largely necrotising and produces shock, haemolysis and haemorrhage. Anticoagulant activity may result from destruction of fibrinogen or prothrombin, inhibition of thrombin formation, destruction of platlets or in vivo- defibrination with formation of minute fibrin emboli. Immunodiffusion techniques indieate that snake venoms contain 6 to 16 antigens. Viper venom is antigenically more complex. All the features of haemolysis, haemorrhage and other anticoagulant activities are suggestive of a viper bite in this case.
| Summary|| |
A case of viper bite with bleeding convulsions, haematuria, subarachnoid haemorrhage, exotropia conjunctival haemorrhage, nystagmus and papilloedema has been reported. This is perhaps the first case with many ocular complications encountered so far.
| Acknowledgement|| |
We are thankful to Dr. K.D. Gupta, Principal and controller, S.P. Medical College, Bikaner, for his permission to publish this case report.
| References|| |
Alvaro, M.E,, 1939, Amer. J. ophthal., 22,
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Cuttman-Friedman, A , 1956, Brit. J. Opthal. 40, 57.
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