A Case Report of Rattlesnake Musk Exposure Causing Chemical Conjunctivitis

Rattlesnakes are pit vipers belonging to the Viperidae family and Crotalinae subfamily. They inject venom into their victims via bites from two long, hollow fangs. When disturbed, they can release a liquid musk from cloacal scent glands into the air. This report describes a rare case of non-penetrating rattlesnake ocular exposure with symptoms. We also discuss pathophysiology, evaluation, and treatment recommendations.

A 56-year-old male picked up a rattlesnake and was sprayed in both eyes with liquid emanating from the snake. He was not bitten by the snake. He had immediate pain and blurred vision. Despite copious initial irrigation, he continued to have worsening symptoms with subconjunctival hemorrhage and scleral injection. After discussion with poison control, he was given six vials of intravenous (IV) antivenom. After additional irrigation and evaluation by ophthalmology, the patient's symptoms stabilized, but his exam still included blepharitis, subconjunctival hemorrhages, and bilateral, small corneal epithelial defects. He was discharged home with corneal antibiotics and artificial tears. One week later his symptoms were resolved, and his exam was normal.

Non-penetrating musk ocular rattlesnake exposure is rare. In certain conditions, it may be from exposure to snake musk from scent glands and not venom. It should be treated as any other ocular exposure beginning with copious irrigation and then a detailed examination. Current recommendations argue against IV antivenom administration.