Very mild bilateral ptosis following snakebite

A 22-year-old male construction worker in Eastern Samar, Philippines, was bitten on his right leg by a black and yellow snake in the coastal area. Despite receiving a local remedy, he was later brought to the emergency department. Twelve hours post-bite, careful examination revealed mild bilateral ptosis, with the patient struggling to keep his eyes open, especially during upward gaze (Figure 1A). The bite site showed mild swelling, tenderness, and two fang marks. Although the snake responsible was not conclusively identified, based on the geographical distribution, snake description, and clinical signs, Naja samarensis envenomation was suspected. Intravenous administration of Purified Cobra Antivenom (Research Institute for Tropical Medicine)1 significantly improved eye-opening ability within 30 min: the patient could open his eyes fully and sustain eye-opening (Figure 1B).