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Case report.
A previously healthy 54-year-old woman presented to the emergency department with vomiting and severe pain in her right ring finger following scorpion envenomation. She had been stung 6 hours before while culling herbs in a semirural area near the northeast highlands of Tehran.
At admission, her vital signs were stable. Physical examination revealed an inflamed, mildly bruised, tender right ring finger with hyperesthesia. The rest of the examination showed no abnormalities. She received broad-spectrum antibiotics, hydrocortisone, ibuprofen, and promethazine. On the 3rd day of hospitalization, she developed blurred vision and diplopia that was aggravated by looking at near objects. On neurologic examination, visual acuity in both eyes was 20/20, and there was bilateral ptosis, which was more prominent on right side. Funduscopy results were normal. Globes were deviated outward and slightly downward. Pupils were bilaterally dilated, symmetric, and nonreactive (size 7 mm), and accommodation was lost. Adduction, elevation, and depression of both eyes were limited, but abduction was preserved. Intorsion was evident in …
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