A 32-year old male walked into the emergency department with the complaint of double vision. The patient revealed that he was bitten by a snake while working in the fields two days ago. He did not seek any treatment at that time. On examination, the patient was found to have a small wound on his right calf consistent with a bite mark. The area was exquisitely tender and surrounded by a 2 cm area of brown discoloration. There were no signs of compartment syndrome. Ocular examination showed bilateral ptosis and ophthalmoplegia on lateral gaze. The pupils were reactive to light. The corneas were clear and fundoscopy was unremarkable. The rest of the physical examination was normal. Apart from slightly elevated liver enzymes and mild neutrophilic leukocytosis, laboratory values including coagulation profile, Creatinine Kinase, and renal function tests were normal. The patient was given antivenom, amoxicillin/clavulanate, and ibuprofen. The patient was shifted to medical floors for observation. He did not develop any other neurological complications. A gradual resolution of diplopia and ptosis was observed and the patient was discharged home after 2 days. There was a complete resolution of diplopia and ptosis on follow-up three weeks later.

Keywords: Snakebite; Ptosis; Diplopia