|Year : 1977 | Volume
| Issue : 2 | Page : 1-2
A case of bilateral vitreous haemorrhage following snake bite
B Manohar Rao
Kasturbha Medical College, Mangalore, India
B Manohar Rao
Kasturbha Medical College, Mangalore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rao B M. A case of bilateral vitreous haemorrhage following snake bite. Indian J Ophthalmol 1977;25:1-2
India being a tropical country abounds in snakes of great varieties, poisonous as well as harmless. Besides a painful conjunctivitis and palpebral oedema, which occurs when venom is sprayed or `spat' into the eyes by certain Cobras in Asia and Africa, ocular complications due to snake bite is relatively unknown.
| Case Report|| |
M.R. aged 46 years, Hindu male, resident of Sullia, attended the Eye OPD of the Government Wenlock Hospital, Mangalore with the complaint of loss of vision in both eyes of 20 days duration, following a snake bite.
While working in a forest almost eight weeks ago he was bitten by a snake on his left leg. The snake was about two feet in length and brownish colour, presumably a viper since its occurence is common in the region.
He killed the snake and burnt it. He lost conciousness in about two hours after the bite. He was admitted unconscious in Patro Hospital, Puttur for 2 days and then in Government Hospital Puttur, for 7 days, where he received prompt medical treatment including antivenin and local treatment to his left leg. His relatives sought discharge from the hospital against medical advice as he did not regain consciousness and his general condition deteriorated. However, after being treated at home by a 'native Doctor' he regained conciousness in a week's time but found himself totally blind. He could appreciate light when bright light was shown in his eyes. He did not seek medical advise since he felt very weak. In the following 20 days there was no improvement as regards his eye sight but he recovered well bodily and mentally. His medical records could not be obtained.
The patient was of average built and nutrition. Systemic examination including skin was normal. Blood pressure was 130/80mm Hg.
Pupils: Semi-dilated and reacted sluggishly to light.
There was a reddish brown reflex in the pupillary areas of both the eyes.
Fundus: No glow seen due to vitreous haemorrhage in both eyes.
Vision in both eyes: Perception of light was present. Projection of light was doubtful.
Hb. 90% Bleeding time: 2
Total Leucocytic count: 7,700 Clotting time: 8 cells/cmm. minutes Differential count: P s . 2 L~ s. Platelet count: 250
E.S.R.: 8mm/1st hour R.BC. Fragility test:
Fasting blood sugar:
Urine and stool examinations were normal.
The patient was referred to a competent Physician. His cryptic remarks were 'We are as much in the dark as the ophthalmologist and the patient.' However his prolonged coma could be explained to be probably due to haemotoxicity and/or haemolysis leading to a subarchnoid or cerebral haemorrhage. Since the patient had come so late blood picture had settled to normal. C.S.F. Examination was not indicated.
Bed rest, Vitamin C 500mg daily, Ranodine course of 10 injections daily, Tablets Prednisolone 40mg daily were given.
There was no improvement in vision in the first 10 days and the pupils were fully dilated and fixed.
As a last resort it was decided to aspirate some of the vitreous.
Surgery Right Eye
Under General anaesthesia, a conjunctival flap was made 10mm from the limbus in the infero lateral quadrant. A small lamellar scleral trapdoor was dissected and the Ora serrata was pierced through with a wide bore needle into the vitreous cavity. About four cc of greenish brown fluid was aspirated and was replaced with an equal amount of sterile normal saline.
Microscopy and chemical examination of the aspirated fluid revealed it to be of blood clements.
Culture report of the fluid was 'Sterile'. In the subsequent two weeks time following operation, the patient lost his perception of light in the operated eye. The pupillary reflex became yellowish in both eyes probably due to organised vitreous haemorrhage. Tension of the cyes was normal till the time of discharge.
| Discussion|| |
The case of a 46 year old man who lost his eye-sight due to bilateral vitreous haemorrhage following snake bite is reported. The case is interesting from several points of view.
1. Vitreous Haemorrhage, following a snake bite, has not been reported in the available literature.
2. Since the patient discovered blindness only on regaining consciousness after prolonged state of coma of 16 days duration an untoward eye complication could not have been anticipated.
3. The venom of viper acts mainly on blood and blood vessels. Widespread haemorrhages into the skin and mucous membranes, epistaxis, haematemesis and blood diarrhoea resulting in circulatory collapse are usually seen and death may occur in six to 48 hrs. Haemorrhages may occur in the dura, subarachnoid space, brain and other organs  This could possibly explain the vitreous haemorrhage in the present case.
4. Thus, the vitreous haemorrhage in this case could have been due to the following factors:
(i) The venom acting on blood and blood vessels resulting in widespread haemorrhages.
(ii) Haemopoietic disease as a result of snake bite-like severe anaemia, thrombocytopaenia purpura etc., may have given rise to a retinal haemorrhages which percolated into the vitreous.
(iii) Duke Elder mentions 'In cases of subarachnoid Haemorrhage the rupture of a subhyaloid haemorrhage may result in a considerable infiltration of the vitreous' among the causes of vitreous haemorrhage.
| References|| |
Duke Elder, 1967, System of ophthal. Vol. XI
Henry Kimpton, London.
G.M. Edington and H.M. Gilles, 1976. Pathology in the Tropics ELBS,
A Vijjajiva 1976, Tropical Neurology
Ed. by John D Spillane. Oxford University Press, London.
Price's Text book of the Practice of Medicine Ed. by
Sir Ronald Bodley Scott.