Venom ophthalmia and acute angle closure glaucoma in capillary leak syndrome.

Abstract

Purpose: To investigate the incidence and management of acute angle-closure glaucoma (ACG) following venomous snakebites, along with its associated systemic complications, and to evaluate the importance of early detection and intervention in preventing long-term visual impairment.

Design: Prospective interventional case series.

Method: This study included patients admitted with venomous snakebites to a tertiary care hospital in rural Tamil Nadu, India, over four years (March 2019 to August 2023). All patients underwent both systemic and ocular assessments, regardless of their presenting symptoms. Ocular complications, particularly ACG, were managed with topical and systemic treatments. Data collected included demographic information, type of snakebite, systemic symptoms, treatment outcomes, and ocular findings.

Results: Of the 126 patients admitted with venomous snakebites, 84 presented with neurotoxic bites and 42 with hematotoxic bites. Nine patients developed bilateral ACG, all of whom had sustained hematotoxic bites. Visual acuity (VA) ranged from hand motion to 6/9, with elevated intraocular pressure (IOP) ranging between 12 and 54 mm of Hg. Systemic complications included acute renal failure in 16 hematotoxic cases, with four patients requiring hemodialysis and subsequently succumbing to renal failure and multiorgan dysfunction. After treatment with antisnake venom, topical IOP-lowering agents, corticosteroids, and systemic therapies, five patients demonstrated full recovery, with normalized IOP and improved VA.

Conclusion: ACG is a significant but underreported complication of hematotoxic snakebites. Early detection and intervention, including routine ocular screening, are crucial to prevent visual impairment. Ocular involvement may also serve as a prognostic indicator of severe systemic envenomation.