Early management of snake venom ophthalmia leads to fast rec
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Venom ophthalmia is a rare ocular condition caused by exposure of the eye to the venom of a spitting cobra. Corneal and ocular surface damage is predominant after exposure to snake spitting. Prompt diagnosis and immediate medical management prevent permanent vision loss due to corneal opacity in such cases.

A 65-year-old male patient presented with pain, watering, and decreased vision immediately after experiencing snake spit in his left eye. On examination, uncorrected visual acuity in the left eye was 20/800 and did not improve with pinhole. Slit-lamp examination revealed conjunctival congestion, chemosis, and diffuse corneal stromal edema with Descemet’s membrane folds. The pupil was mydriatic with a limited view of the fundus but with a red glow present. A single drop of topical proparacaine 0.5% was instilled, and the conjunctival sac was washed with a copious amount of normal saline. The patient was advised to use 1% hydroxypropyl methylcellulose twice hourly and 0.5% moxifloxacin four times a day, with follow-up on days 1, 7, and 14. At the last follow-up, the cornea was clear and Descemet’s membrane folds resolved with uncorrected visual acuity of 20/20. The pupil also regained its normal size and reaction on day 14 without any additional medication.

Venom ophthalmia is an ocular condition caused by exposure of the eye to the venom of the spitting cobra. Snakes of these species have characteristic fangs with anteriorly faced openings, which allow a spray of venom up to a distance of 2 m as a defense mechanism. Although spitting is the primary route of venom transfer, these snakes can also directly transfer venom via a bite. Patients of venom ophthalmia usually present with photophobia, watering, pain, and blurred vision. These symptoms are attributed to epithelial breakdown and corneal edema induced by the cytotoxic properties of the venom. Management included copious irrigation to wash out the venom, lubricants and prophylactic antibiotics. It is important to counsel such patients about the risks associated with traditional medications such as lime juice and potash. Topical steroids are contraindicated to avoid further melt of the cornea and risk for infection.

Source: https://www.healio.com/news/ophthalmology/20200729/early-management-of-snake-venom-ophthalmia-leads-to-fast-recovery
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