Takeshita Tetsuji, Yamada Kazuhiro, Hanada Masakazu, Oda-Ueda Naoko
Department of Ophthalmology, Yamaga City Hospital, 511 Yamaga, Yamaga 861-0593, Kumamoto, Japan.
Kobe J Med Sci. 2003;49(1-2):11-5.
A 51 year-old man presented with binocular diplopia on the three days after the snakebite in the fifth finger of the right hand by an Agkistrodon blomhoffi (mamushi). In the primary position he had an exotropia and right hypertropia, which became apparent when his head was tilted to the right. From ocular angle of deviation measured by synoptophore and Hess chart test, he was diagnosed as having medial rectus muscle paresis as well as inferior oblique muscle paresis of the left eye. Elevation deficit on right gaze in the left eye had remained during three days. Our case suggested that the occurrence of subjective binocular diplopia is an important clinical sign for the onset of general abnormalities caused by snakebite.
一名51岁男性在右手无名指被日本蝮蛇（草腹链蛇）咬伤三天后出现双眼复视。在第一眼位时他有外斜视和右眼上斜视，当他的头向右侧倾斜时更为明显。通过同视机和Hess屏检查测量眼位偏斜角度，他被诊断为左眼内直肌麻痹以及下斜肌麻痹。在三天内左眼向右注视时的上抬不足一直存在。我们的病例表明，主观双眼复视的出现是蛇咬伤引起全身异常发作的一个重要临床体征。
