Presumed Ischemic Unilateral Oculomotor Nerve Palsy Developing after a Snake Bite
10.3341/jkos.2020.61.7.839
- Author:
Seung Chul BAEK
1
;
Won Jae KIM
Author Information
1. Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
- Publication Type:Case Report
- From:Journal of the Korean Ophthalmological Society
2020;61(7):839-842
- CountryRepublic of Korea
-
Abstract:
Purpose:We report a patient with presumed ischemic unilateral oculomotor nerve palsy developing after a snake bite on the right finger.Case summary: A 58-year-old male visited our emergency department complaining of right ptosis and binocular diplopia that had developed after a snake bite. He had been bitten on a finger of the right hand by an unidentified snake about 6 hours prior to symptom onset. He lacked neurological symptoms such as headache, nausea, vomiting, or an altered consciousness level. The right hand exhibited severe swelling, oozing, and inflammation. The visual acuity was 20/25 in both eyes. Ptosis was evident in the right eye. Both pupils responded normally to light and near stimulation. Extraocular examination revealed movement limitations in all right-eye gaze fields except abduction. A serological test revealed coagulopathy. Pyridostigmine was prescribed, but the ocular symptoms did not immediately improve; however, they did improve gradually during follow-up. At 8 months after the initial visit, the patient exhibited an ortho primary gaze with an adduction limitation of -1. No aberrant regeneration was apparent.
Conclusions:Unilateral oculomotor nerve palsy can develop after a snake bite, possibly attributable to microvascular ischemia caused by coagulopathy.
