Bilateral corneal melting following snakebite neurotoxicity
A 45 year old male, farmer by occupation, had a history of snake bite 25 days back in the second finger of the left hand. After the bite, he tied his upper arm with vinyl cloth and was brought by his wife and daughter to the trauma centre of our hospital. The patient also had a history of unconsciousness for 10 days after 24 hours of snakebite.

He was admitted in the ICU and was referred to the ophthalmology unit. He presented with complaints of inability to open both eyes, redness, watering, photophobia and whitish discoloration of clear central part of both eyes since 15 days.

On examination, the patient had blepharospasm and limb weakness. He was unable to walk, walk with the support of another person. His visual acuity in both eyes was finger counting close to face with accurate projection of rays in all quadrants. Anterior segment findings of both eyes showed mildly oedematous lids, marked conjunctival congestion, severe corneal thinning of the cornea with sloughing in the lower part 3mm × 3mm in size, a flat anterior chamber in lower part and shallow AC in upper part, and a cataractous lens. Corneal sensation was decreased in both eyes.

Fundus examination was not possible. Ultrasound B scan done for posterior segment assessment showed no abnormality. Topical antibiotics and cycloplegics were advised after bandage contact lens (BCL) application in both eyes and the patient was kept on close observation. Tectonic kaeratoplasty had to be done in the left eye at 2 weeks due to further worsening of the clinical condition.

The medical records revealed finger swelling and black pigmentation near the bite mark. The patient had received the appropriate antivenom. His blood counts one day following the snakebite were: hemoglobin 14.2gram%, total white blood cells count 14,500/microliter, platelet count 2.6 lacs/ microliter, blood urea 18 milligram/ deciliter and serum creatinine 0.56 milligram/ deciliter.

He was diagnosed as suspected snake bite with neurotoxicity with corneal melting. Systemic condition of the patient had improved after the medical treatment.

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