Systemic Envenomation via Ocular Route from a Neurotoxic Snake Venom Ophthalmia--A Case Report

Snake envenomation is a neglected tropical disease with two million snake bites reported each year (WHO). Much less common is snake venom ophthalmia secondary to eye exposure from spitting snakes. This paper reports an unusual case of systemic envenomation via the ocular route of a 14-year old male from the Philippines. A mixture of snake blood and venom came in contact with the patient's left eye causing severe pain and blurring of vision, shortly followed by generalized body weakness and ptosis. Copious irrigation with normal saline was done at the emergency room, and Purified Cobra Antivenin (PCAV) was administered. Symptoms of systemic envenomation abated following PCAV administration. Ofloxacin ophthalmic drops and eye lubrication were prescribed for seven days to minimize complications, and the patient was discharged well after three days of hospitalization. Although difficult to ascertain, signs and symptoms pointed to systemic envenomation, and this could be the first case of an unconventional venom route to date. This paper opens possibilities and serves as precedent for future research - ocular envenomation, snake venom, and blood components, and symptomatic management.