ACUTE ANGLE CLOSURE GLAUCOMA WITH CAPILLARY LEAK
SYNDROME FOLLOWING SNAKE BITE
Introduction
• Snake bite is a major public health problem in Tamil Nadu.
• Poisonous snakes are more prevalent in Salem.
• Venomous Snake bite presents with multiple systemic
effects, however ophthalmic complications are rare.
• Ocular manifestations range from direct injury to eye
leading to penetrating injuries with bite marks, conjunctival
and corneal lacerations, subconjunctival hemorrhage,
uveitis, acute angle closure glaucoma, optic neuritis,
external ophthalmoplegia, vitreous hemorrhage and
endophthalmitis.
• Hereby we present a case of snake bite with unusual
complication. Hereby we present a case of bilateral acute
angle closure glaucoma with capillary leak syndrome and
acute renal failure secondary to hematotoxic snake bite.
Case Description
• A 66-year-old male presented with complaints of alleged
history of snake bite over his right foot at 4:00pm at his
workplace. Patient reached hospital 4 hours later at
8:00pm.At admission, patient was conscious, oriented, no
pallor, no pedal edema with local cellulitis upto ankle.
WBCT is prolonged, following 10 vials of ASV given. Vitals
are stable at admission.
• Routine investigations showed TC-18500cells/mm3, HB-
12.3gm/dl,plt-1.72lks/mm3, Blood urea-36, sr.cr-1.2.
• Again WBCT- was repeated after 6 hrs which was also
prolonged, following which 8 vials of ASV given. Again
WBCT- was repeated after 6 hrs which was also
prolonged, following which 8 vials of ASV given.
Dr. Sowmya S, Postgraduate, Department of General Medicine, GMKMCH.SALEM.,
Dr. Elanchezian M.D, Professor of General Medicine, GMKMCH.SALEM.
Case Description
• At day 2 by 8.00 pm, patient developed headache,
redness of eyes and blurring of vision, followed by Day-1
periorbital edema, facial puffiness. USG abdomen
shows- increased renal cortical echoes, mild to mod
ascites, diffuse GB wall edema.
• Emergency CT brain was done which was normal. Left Eye Right Eye
Ophthalmology consultation was obtained which
showed B/L acute angle closure glaucoma with IOP of
42.5mmHg with shallow anterior chamber associated Day-9
with chemosis. Fundus examination- B/E No view due
to corneal edema. Patient was started on
T.acetazolamide ,Timolol eye drops and Inj.Mannitol.
• On day 2,patient RFT showed B.urea-68 S cr-2.4, TC- Conclusiion
28000 with urine output of 600 ml in past 6 hrs. • Acute angle closure glaucoma, though rare can be
Inj.Mannitol was withheld. vision threatening complication of hematotoxic
• Patient was managed conservatively with IV fluids snake bite.
and antibiotics. • The incidence of angle closure rises markedly with
• Patient right foot cellulitis has progressed upto knee, capillary leak syndrome and renal failure.
• Usually decreased vision is first symptom of such
following which 5 vials of ASV was transfused,
cases and has to be kept in mind by emergency
• On day 3, patient developed facial puffiness and
room and intensive care unit staff for early
periorbital puffiness and his renal parameters
recognition of this condition.
worsened with RFT-134,S.Cr-3.1 with urine
• Finally, if recognised early, this complication has
output<100 ml in last 6 hrs.,so taken up for
good to excellent visual prognosis.
emergency hemodialysis using IJV catheter.
• Inj.Mannitol was given before each hemodialysis
• Three more cycles of HD was done on day 5,7 and 9 References
• On day 9, patient symptomatically improved and IOP
Kumar KV, Kumar SP. “Bilateral acute angle closure
declined to 19mm Hg.
glaucoma following a snake bite: Are we missing
• His renal parameters started improving on day 10
it?”Indian J Crit Care Med. 2016 Jan;20(1):40-3. doi:
with B.urea-100,S.cr-2.1 with urine output 900 ml in
10.4103/0972-5229.173688. Retraction in: Indian J Crit
last 8 hrs. Patient was discharged on day 13 with
normal renal parameters. Care Med