Ocular manifestations of snake bites in a tertiary care hospital in rural Northern Kerala, India

Twinkle Ann George, Asha A. V., Risha Ravindran, Latha N. V.


Background: Snake bite is a neglected public health problem worldwide especially in the tropics. Studies on ocular manifestations are still fragmentary. The objective of the study was to find ocular manifestations among the snake bite cases with systemic envenomation admitted in the intensive care units in a tertiary care hospital in rural North Kerala, India during a period of 4 years from May 2012 to May 2016.

Methods: It was a prospective, observational, cross sectional study. Institutional ethical committee approval was obtained for the study. A descriptive analysis of snake bite cases with systemic envenomation was done.  Other snake bites are excluded from the study. Patients who needed ophthalmological opinion for ocular symptoms were analyzed.

Results: Total suspected snake bites admitted in ICUs during the study period were 638. Only 7 patients (1%) with haematotoxic envenomation needed ophthalmological opinion for ocular symptoms. Patients in the present study ranged between the age of 11 and 53. Ocular lesions diagnosed among the 6 patients who developed capillary leak syndrome, were bilateral angle closure glaucoma in 3 patients, pan uveitis, disc edema and retinal haemorrhages in 2 patients, bilateral macular oedema. Youngest patient had intracranial haemorrhage and bilateral orbital hemorrhage, leading to exposure keratitis. SAV was administered in all patients ranging from 11-30 vials. All the patients except the patient with orbital haemorrhage had a grave prognosis. Still only one of these patients expired on day 3, rest all patients had better vision and survived due to timely management.

Conclusions: A timely intervention especially at the initial presentation of capillary leak syndrome, can decrease the morbidity and save the life of a patient.


Bilateral angle closure glaucoma, Capillary leak syndrome, Disc oedema, Haematotoxic bites, Macular oedema, Orbital haemorrhage, Pan uveitis, Periorbital oedema, Renal failure, Retinal haemorrhages

Full Text:



Ray G, Parija BL, Kumar LR. Assessment of severity of snake bite. Medicine Update. Adv Management Snake Bite. 2011 p539

Bhalla G, Mhaskar D, Agarwal A. A study of clinical profile of snake bite at a tertiary care centre. Toxicol Int. 2014;21(2):203-8.

Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A clinico-epidemiological study of snake bite in Nepal. Tropical Doctor. 1998;28:223-6.

Kulkarni ML, Anees S. Snake venom Poisoning: experience with 633 cases. Indian Pediatr. 1994;31:1239-44.

Saini RK, Sharma S, Singh S, Pathania NS. Snake bite poisoning. A preliminary report. J Assoc Physicians India 1984;32(2):195-7.

Chavan WM, Chavan KD. Ocular manifestations in patients with snakebite in rural Western Maharashtra. Indian J Forensic Med Pathol. 2011;4(4):169-72

Suchitra N, Sujathan P, Pappachan JM . Snake bite envenoming in Kerala, South India, Clinical profile and factors involved in adverse outcomes. Emerg Med J. 2008;25(4):200-4.

Lahori UC, Sharma DB, Gupta KB. Snake bite poisoning in children. Indian Paediatr. 1981;18:193-7.

Kumar KVP, Kumar S, Kasturi N, Ahuja S. Ocular manifestations of venomous snake bite over a one-year period in a tertiary care hospital: Korean J Ophthalmol. 2015; 29(4):256-62.

Srinivasan R, Kaliaperumal S, Dutta TK. Bilateral angle closure glaucoma following snakebite. J Assoc Physicians India. 2005;53:46-8.

Shivaprasad C, Srinivasan R, Nongrum B, Ganne P. Effect of snake bite on intraocular pressure. 70th AIOC Proceedings, Cochin 2012, Glaucoma free papers. 2012;348-50.

Appukuttan A, Kalaiperumal SR, Srinivasan, Rao V. Bilateral angle closure with raised intraocular pressure following snake bite. www.oic.wgc2011/ pdf/abstracts/p329-444.

Haneef M, Verma VA. Acute angle closure glaucoma: rare complication of viper bite. Kerala Med J. 2008;2:27-8.

Preethi, Manikandan, Janaki JM. Bilateral angle closure glaucoma following snake bite. J Tamil Ophth Assoc. 2009;47:4:115-6.

Kulkarni C, George TA, Asha AV, Ravindran R. Acute angle closure glaucoma with capillary leak syndrome following snake bite. JCDR. 2014;8(10):VC01-3.

Davenport RC, Budden FH. Loss of sight following snake bite. Br J Ophthalmol 1953;37:119-21.

Olcaysu OO, Cadirci K. Unilateral optic neuropathy and acute angle-closure glaucoma following snake envenomation. Case Rep Ophthalmol Med. 2015;2015:687829.

Buttes GP, Ayan N, Cami G. Uveitis after snakebite. Arch Pediatr. 1996;3:832-3.

Kumar PK, Ahuja S, Kumar PS. Bilateral acute anterior uveitis and optic disc edema following a snake bite. Korean J Ophthalmol. 2014;28(2):186-8.

Nayak SG, Satish R, Nityanandam S, Thomas RK. Uveitis following anti-snake venom therapy. J Venom Anim Toxins Incl Trop Dis. 2007;13:130-4.

Rojas L, Ortiz G, Gutiérrez M, Corredor S. Ghost cell glaucoma related to snake poisoning. Arch Ophthalmol. 2001;119:1212-3.

Singh S, Singh G. Snake bite: Indian Guidelines and chap94.pdf

Dutta J, Sen S, Bera SK, Datta H. An unusual case of bilateral retinal haemorrhage following snakebite. Ocul Biol Dis Inform. 2011;4:159-60.

Singh J, Singh P, Singh R, Vig VK. Macular infarction following viperine snake bite. Arch Ophthalmol. 2007;125:1430-1.

Rajappa GC, Asuti S, Gupta CN, Sudhir U. Central retinal artery occlusion: A rare complication of viperine snake bite. JIACM. 2014;15(2):160-1.

Bhalla A, Jain AP, Banait S. Central retinal artery occlusion: an unusual complication of snakebite. J Venom Anim Toxins Trop Dis. 2004;10:311-4.

Tungpakorn N. Unusual visual loss after snakebite. J Venom Anim Toxinsincl Trop Dis. 2010; 16(3):519-23.

Guttmann A, Freidmann. Blindness after snake bite. Br J Ophthalmol. 1956:40:57-9.

Rao KV. Optic neuritis and ophthalmoplegia caused by snake bite. Indian J Ophthalmol. 1981;29:243-45.

Mathur SP. Allergy to antivenine serum. Br J Ophthalmol. 1959;43:50-1.

Menon V, Tandon R, Sharma T, Gupta A. Optic neuritis following snake bite. Indian J Ophthalmol. 1997;45:236-37.

Mustapha SK, Mubi BM, Askira BH. Bilateral blindness following snakebite. Trop Doct. 2010;40:117-8.

Subasinghe CJ. Bilateral blindness following Russell’s viper bite- a rare clinical presentation: a case report. J Medical Case Rep. 2014;8:99.

Rao BM. A case of bilateral vitreous haemorrhage following snake bite. Indian J Ophthalmol. 1977;25:1-2.

Iqbal M, Khan BS, Ahmad I. Endogenous endophthalmitis associated with snake bite. Pak J Ophthalmol. 2009;25:114-6.

Naik R. Orbital cellulitis and pyogenic meningitis rare sequelae after snake bite. Int J Res Med Sci. 2016;4(5):1742-5.