Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait

Area of Science:

• Ophthalmology
• Toxicology
• Neurology

Background:

• Snakebite envenomation (SBE) in India is primarily caused by the "Big Four" snakes, leading to common effects like neurotoxicity and coagulopathy.
• Rare complications of SBE include priapism, pseudoaneurysm, and sialolithiasis.
• Ocular manifestations, such as optic neuritis, are rare but can cause vision loss, especially following envenomation by non-spitting snakes.

Observation:

• Optic neuritis following Indian cobra envenomation has been documented.
• This report details the first observed case of optic neuritis in a victim envenomated by a common krait.
• Both patients, one with common krait SBE and another with Indian cobra SBE, developed optic neuritis days after initial recovery from antivenom treatment.

Findings:

• Ophthalmic examination, CT, and MRI confirmed optic neuritis in both patients.
• Clinical features of optic neuritis were similar in both the common krait and Indian cobra envenomation cases.
• Intravenous corticosteroid treatment successfully restored vision in both patients.

Implications:

• Optic neuritis following common krait envenomation is clinically similar to that caused by Indian cobra bites.
• Standard diagnostic and therapeutic strategies for cobra bite-induced optic neuritis are applicable to common krait bites.
• This study highlights the need for increased awareness and provides guidance for managing this rare SBE complication.