Exotropia caused by pit viper snakebite.

Pit viper snake venom exerts a mildly neurotoxic effect that may rarely lead to neurotoxic complications, such as paralytic strabismus. Extraocular muscles are known to be particularly susceptible to this complication. In previously reported cases, the medial rectus muscle has been the most frequently involved. We report the first case of a pit viper snakebite resulting in comitant exotropia without obvious paralytic features.