Coluber Constrictor Bite to the Eye: A Novel Case Report of a Wild Snake Bite to the Eye in North America and Review of Literature.

ABSTRACT

Snake bites involving the eye are an uncommon cause of ocular trauma; herein, we present one of the few known instances of a snake bite directly to the globe, specifically by the way of a Coluber constrictor, also known as the "Black Racer." In this case report, we describe a nine-year-old girl who presented immediately following a snake bite to the right eye. The patient's vision was unaffected despite visualized puncture wounds through the conjunctiva with associated near-total subconjunctival hemorrhage. The patient was taken to the operating room emergently for globe exploration. Circumferential peritomy and direct view to the sclera did not reveal any lacerations or puncture and subconjunctival vancomycin, gentamycin, and dexamethasone were administered intraoperatively. Post-operatively, the patient was discharged on a regimen of oral Cephalexin. Throughout multiple follow-ups, she continued to maintain excellent vision without sequelae. Trauma to the globe via snake bite is an exceedingly rare occurrence. Upon literature review, three out of three cases involving venomous snakes resulted in "No Light Perception" vision despite anti-venom. While nonvenomous snake bites may lend a better visual outcome, if not treated properly they may also yield poor final visual potential. Methods of treatment include oral or subconjunctival antibiotic administration with or without a steroid or cycloplegic agent. All reported cases of nonvenomous cases ultimately resulted in excellent visual potential (20/40 or better) and no reports of endophthalmitis. As such, it is evident that identifying the species of snake is of the utmost importance when considering visual prognosis. Due to very few reported incidences of globe trauma via snake bite, there is no mainstay therapy for either the venomous or nonvenomous snake bite variety. Despite this, we encourage careful pursuance of the appropriate therapy on a case-by-case basis, considering operative treatment, antivenom (if necessary), and antibiotic coverage with possible cycloplegia and steroid administration.