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Abstract
Purpose
To describe the therapeutic effect of anticholinesterase treatment for patients with paralytic strabismus and blepharoptosis following a viper bite
Methods
A prospective non-comparative interventional case series study was designed including 6 patients with ophthalmic complications such as paralytic strabismus and blepharoptosis following a viper bite. Anticholinesterase (pyridostigmine) 60 mg was administered to patients 3 times a day in additional to conservative treatment including antivenom, antibiotics and tetanus toxoid. Patients underwent a measurement of deviation, diplopia test and MRD 1. Subjective evaluation of the diplopia symptoms was performed daily after treatment.
Results
Subjective diplopia was relieved in 2 out of the 6 patients on the first day and in the other 4 patients on the second day. The angle of deviation decreased approximately 37% on the first day and ocular position became orthophoric on the third day in all patients. The blepharoptosis was completely resolved in 4 patients on the first day. No complication following anticholinesterase treatment was noticed.
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References
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 | Figure 1.Fang marks of patients on the left forearm (Case 2, A), the right middle finger (Case 3, B), the left ankle (Case 4, C) and the left thumb (Case 6, D) with an erythematous swelling and pain after a viper bite. |
 | Figure 2.Nine cardinal photographs of 50-year-old male patient after a viper bite (Case 3, A) and 53-year-old male patient after a viper bite (Case 4, B). Exotropia at distance and the mild limitation of the left eye at right gaze. |
 | Figure 3.Nine cardinal photographs of same patients (Case 3, A), (Case 4, B). Exotropia and the limitation of the left eye were resolved after anticholinesterase treatment. |
 | Figure 4.Photographs of a 50-year-old male patient after a viper bite (Case 3). The ptosis of both lid and paralytic exotropia at distance without the limitation of the eye movement (A) and the resolution of lid ptosis and paralytic exotropia after one day of anticholinesterase treatment (B). |
Table 1.
Summary of subjective diplopia before & after anticholinesterase treatment
| Case (No) | Age (Year) | Sex | Subjective diplopia (Grade) | ||
|---|---|---|---|---|---|
| Premedication | Day 1 | Day 2 | |||
| 1 | 9 | M | 2 | 0 | |
| 2 | 31 | M | 3 | 1 | 0 |
| 3 | 50 | M | 3 | 1 | 0 |
| 4 | 53 | M | 2 | 1 | 0 |
| 5 | 67 | F | 3 | 1 | 0 |
| 6 | 68 | M | 2 | 1 | 0 |
Table 2.
Summary of paralytic strabismus before & after anticholinesterase treatment
| Case (No) | Age (Year) | Sex | Deviation of angle at primary gaze | |||
|---|---|---|---|---|---|---|
| Premedication | Day 1 | Day 2 | Day 3 | |||
| 1 | 9 | M | 10PD* XT 2PD LHT‡ | 6PD XT† 2PD LHT | 6PD XT | Orthophoric |
| 2 | 31 | M | 15PD XT 4PD LHT | 12PD XT | 2PD XT | Orthophoric |
| 3 | 50 | M | 10PD XT | 4PD XT | 2PD XT | Orthophoric |
| 4 | 53 | M | 15PD XT | 12PD XT | 6PD XT | Orthophoric |
| 5 | 67 | F | 15PD XT 4PD LHT | 10PD XT | 2PD XT | Orthophoric |
| 6 | 68 | M | 8PD XT | 2PD XT | Orthophoric | |
Table 3.
Summary of blepharoptosis before & after anticholinesterase treatment
Table 4.
Comparison of recovery periods according to treatment modalities in paralytic strabismus and blepharoptosis following viper bite
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