BLINDNESS AFTER SNAKE-BITE

Abstract

REPORTS of blindness produced by snake-bite are extremely rare.In one case described recently by Davenport and Budden (1953) bilateral secondary optic atrophy developed; the patient received Antivenine serum on the day of the bite and the changes in the eyes first appeared 6 days later.Jaksch (1897) mentions cases in which snake-bite led to amaurosis, but gives no detailed descriptions or ophthalmoscopic findings.Oettingen (1952) mentions cases of sudden amaurosis and paralysis of the ocular apparatus, but gives no details.Case Report A man aged 40 was admitted to hospital on June 14, 1954, having been bitten in the left leg by Vipera Lebetina Gray.He was in a state of severe shock, with nausea, vomiting, and a rapid weak pulse.Shortly after the accident a tourniquet had been applied to the leg and kept there for 24 hrs with interruptions of 5 minutes every hour.This left leg was already slightly swollen.The temperature was 37 6°C.Blood pressure was 60/ 40 mm.Hg.The patient received Antivenine serum intra-muscularly and transfusions of 2,000 ml.blood and 1,000 ml.physiological saline on the day of admission.Cortisone treatment was started at once, but was continued for only 24 hrs.A few hours after admission the patient had blood in the faeces and the vomiting increased.Next morning the melaena and vomiting ceased, the general condition improved, and the blood pressure rose to 115/75 mm.Hg.The swelling of the bitten leg increased, and subcutaneous haemorrhages and blisters filled with blood-stained serum covered the leg.The bluish discolouration of the tissue reached the region of the umbilicus and the back.Laboratory Tests.-On the third day after admission the haemoglobin was 12 g./100ml., leucocytes 13,600, staphs 2 per cent., polymorphs 62 per cent., eosinophils 1 per cent., lymphocytes 31 per cent., monocytes 4 per cent.The total protein was 5-6 g./l00 ml., albumin 3*3 g./l00 ml., globulin 2-3 g./100 ml.During the following days the haemoglobin dropped to 4-5 g./100 ml.The thrombocytes dropped from 25,000 on the fifth day to 7,000 on the sixth day; therefore cortisone treatment was recommenced, and 24 hours later the thrombocyte count was already normal.The reticulocytes increased from 4*6 to I0 0 per cent.during this period.Two weeks after admission the haemoglobin had increased to 6-5 g./100 ml.A lumbar puncture performed on the 12th day showed no abnormal findings.The x-ray examination of the lungs was negative.General Progress.-Thepatient's general condition improved gradually, the discolouration and swelling of the leg receded and the infected blisters healed under antibiotic treatment.From the third week onwards, the patient was allowed to get up.31 days after admission he left the ward in good general condition.Ophthalmological Findings.-Onthe sixth day, the patient started to complain of blurred vision in both eyes with pain over the globes.Visual acuity in the right eye was finger *