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| ARTICLES |
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| Year : 1981 | Volume
: 29
| Issue : 3 | Page : 243-245 |
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Optic neuritis and ophthalmoplegia caused by snake bite
K Vengala Rao
Guntur Medical College, Guntur, India
Correspondence Address:
K Vengala Rao
Guntur Medical College, Guntur
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 7346436 
How to cite this article:
Rao K V. Optic neuritis and ophthalmoplegia caused by snake bite. Indian J Ophthalmol 1981;29:243-5 |
Nearly 60,000 people are bitten by snakes every year in the Indian subcontinent with a mortality rate of 25%[1]. However, ophthalmic complications in snake bite are rare.[2],[3] This paper discribes two such rare cases, caused by the same snake.
Four days after the cyclonic storm that hit the coastal Andhra Pradesh, 25 cyclone victims were sleeping in the compound of a school near Vijayawada. Same night a 25 years old woman suddenly woke up complaining of piercing pain in the right ear and removed an object which she thought was a rope and threw it away. This fell on another woman who felt piercing pain in the neck. Both saw snake moving away. Both were transferred to the Govt. Hospital, Vijayawada.
Case No. 1:- S-N. 25 years, woman. This was the patient who received the snake bite first.
Condition on admission: Patient was very toxic and was in severe state of shock. There were 2 small abrasions, 2 cms. apart situated on the pinna of right ear. B.P. was 80/60, pulse was 92 per minute. The patient was fully conscious. Examination of cardio vascular and respiratory systems did not revea any abnormality.
C.N.S. Mortor power was poor in all muscles, and all reflexes were affected. There were no sensory disturbances.
Ophthalmic Examination:- There was complete ptosis in both eyes. All the extra ocular movements were absent. Pupils were dilated and fixed.
Vision
Right Eye - Only perception of light.
Left - Eye Counting fingers very close to face.
Fundus Examination - Both optic discs were hyperemic with blurred margins and venous engorgement. The arteries were normal. The picture was suggestive of optic neuritis in both eyes.
Investigations:- Routine Hematological examinations were normal. Urine was normal.
Management:- The patient was put on the following treatment:
Tetanus Toxoid 1/2 c.c.; Streptopenicillin 1 vial daily; 5% Dextrose 2 pints every day for three days alongwith Vit. C 1000 mg.; Lasix 1 amp. 1.M. twice daily; Polyvalent Anti venon I amp. I.V. twice a day; Decadron 1 cc I.M. 6 hourly; Avil 1 amp. twice daily; Inj. B. Complex 2 cc Intramuscular daily.
This treatment was continued for 3 days. On the 4th day Decadron injections were discontinued and Predinsolone 30 mg. was given orally for one week gradually tapering off the dose. Anti venum serum was stopped on 3rd day. Antibiotics and Vitamins were continued for 10 days.
Progress:- The initial recovery was slow. Put from the 4th day the patient regained skeletal muscle power and ophthalmoplegia also showed improvement & V.A. was counting fingers at 3 metres distance. By 7th day the patient regained normal vision (6/6) and the ptosis completely recovered. Extra ocular movements were normal. Skeletal muscles also regained normal power. The patient was discharged on 10th day.
Case No. 2:- V.S. Woman 50 years. This patient received the bite from the same snake soon after the first patient.
Condition on admission:- The patient was toxic and was in a mild state of shock. There were two small abrasions on the right side of the neck, 2 centimetres apart. The patient was fully conscious. Skeletal muscle power was weak. Cardio vascular and respiratory systems were normal.
C.N.S:- Motor power was diminished & reflexes were affected. There was no sensory disturbance.
Ophthalmic Examination:- There was ptosis in both eyes and all the extraocular movements were affected Pupils were semidilated and reacting sluggishly.
Vision:- 6/36 in both eyes.
Fundus:- Optic discs were hyperemic, with blurred Margins, engorged veins & arteries normal. The picture was suggestive of optic neuritis in both eyes.
Management:- Same treatment was given as in the first case.
Progress:- Recovery was complete in 3 days. There was complete recovery of ptosis and extraocular movements. Vision was 6/6 on the 5th day. Patient was discharged on 10th day.
| Discussion | |  |
Ocular complications following snake bite are rare. Snake bite accounts for 4% of all ophthalmoplegias. Optic neuritis following snake bite has not been reported, in the literature. Bilateral blindness due to post neuritic optic atrophy as a result of snake bite has been reported[3].
The two cases reported in this paper developed total ophthalmoplegia and bilateral optic neuritis following snake bite from the same snake. The patient that received the snake bite first showed more severe manifestations compared to the second patient. This may be due to the fact that the first patient might have received larger dose of snake venom compared to the second patient.
Even though the snake was not identified by the patients it can be reasonably concluded from the neurotoxic symptoms the patient developed, that the snake could have been a Cobra.
The neurotoxic effect of Cobra Venom is due to the presence of cholinesterase which hydrolyses acetyl choline at myoneural junctions resulting in muscular paralysis. Both these patients completely recovered from ophthalmoplegia and optic neurits with antivenum serum, steroids and symptomatic treatment. There was no respiratory paralysis in both the cases.
| Summary | | |
Two patients of snake bites from the same snake who developed ophthalmoplegia, optic neuritis skeletal muscle paralysis are presented. There was complete recovery in both the patients with treatment.
| Acknowledgement | | |
I am guteful to Dr. R. Govindarajulu, M.S., Superintendent, Government Hospital, Vijayawada for permitting me to report these cases.
| References | | |
| 1. | Nigam P., Tandon, V.K. R., Thacore, V.R. and Lal, N., 1974, Ind., J. Med. Sc., 27: 697.  |
| 2. | Rao M., 1977, Ind. J, Ophthalmol, 25:11. |
| 3. | Sahai, B. and Sinha, R.H.P., 1978, Ind. J. Ophthalmol., 26,111:16. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
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