INTRODUCTION

Rattlesnakes are pit vipers belonging to the Viperidae family and Crotalinae subfamily.  They inject venom into their victims via bites from two long, hollow fangs.  This report describes a rare case of non-penetrating rattlesnake ocular exposure with symptoms.  Prior reports, pathophysiology, evaluation, and treatment recommendations are also discussed. 

CASE REPORT

A 56-year-old male picked up a rattlesnake and was sprayed in both eyes with venom. He had immediate pain and blurred vision. Despite copious initial irrigation, he continued to have worsening symptoms with conjunctival hemorrhage and scleral sloughing. After discussion with poison control, he was given six vials of intravenous antivenom. After additional irrigation and evaluation by ophthalmology, the patient symptoms stabilized but his exam still included blepharitis, subconjunctival hemorrhages, and bilateral small corneal epithelial defects. He was discharged home with corneal antibiotics and artificial tears. One week later, his symptoms were resolved, and his exam was normal.

CONCLUSION

Non-penetrating ocular rattlesnake envenomation is rare.  It should be treated as any other ocular exposure beginning with copious irrigation, then detailed examination.  Current recommendations argue against intravenous antivenom administration. However, intravenous antivenom can be considered if symptoms do not improve.