Effects of Topical Heparin, Antivenom, Tetracycline and Dexamethasone Treatment in Corneal Injury Resulting from the Venom of the Black Spitting Cobra (<i>Naja sumatrana</i>), in a Rabbit Model

Cham, Gregory; Pan, James C.; Lim, Francis; Earnest, Arul; Gopalakrishnakone, P.

doi:10.1080/15563650600584451

Cited by 19 publications

(20 citation statements)

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“…Topical Haffkine snake antivenom and heparin (5,000 IU/mL) significantly ameliorated the inflammation, scarring, and healed corneal epithelial defects, while 0.1% dexamethasone ointment and 1% tetracycline ointment did no better than the control [7]. To date, there is no human report of the utilization of heparin for ocular envenomation by snake venom.…”

Section: Discussionmentioning

confidence: 97%

Local Antivenom Treatment for Ophthalmic Injuries Caused by a Naja atra

et al. 2010

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We report a case of local antivenom therapy for ocular exposure to the venom of Naja atra. An 83-year-old woman sustained conjunctival and corneal injuries by the venom of a spitting N. atra. Local instillation of N. naja antivenom quickly relieved the pain as measured by visual analog scale, and she recovered uneventfully. Good recovery ensuing topical antivenom administration for ocular exposure to the venom of spitting N. atra and Naja nigricollis has been described in literature, but the pain response was not thoroughly documented. The mechanism of antivenom for pain relief remains to be established. In light of the associated positive outcome observed in human, the role of ocular antivenom therapy merits further study.

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Section: Discussionmentioning

confidence: 97%

Local Antivenom Treatment for Ophthalmic Injuries Caused by a Naja atra

et al. 2010

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“…Its use is based on the fact that the cardiotoxin in snake venom readily binds to the acidic sites in the heparin molecule and renders the cardiotoxin inactive in experimental models. 6 Topical vasoconstrictors or patching of the eyes helps to reduce pain. However, the WHO guidelines published in 2010 advised against the use of topical or intravenous anti-venom and topical corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Snake venom ophthalmia

Vp¹,

Baranwal

2015

Medical Journal Armed Forces India

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“…[5][6][7] The failure of tetracycline in alleviation of ophthalmologic damages in the Naja sumatrana study is not well understood, but a molecular mechanism distinct from that of Naja nigricollis and Hemachatus haemachatus may be in operation. 2 The suboptimal efficacy of Hemachatus haemachatus antivenom might be due to its incomplete neutralisation capacity against the cardiotoxin as demonstrated during ion exchange chromatography study of the crude venom. 4 In one case series, there were 9 patients suffering from Naja nigricollis venom ophthalmia.…”

Section: Discussionmentioning

confidence: 99%

“…Tetracycline (1% ointment) and dexamethasone (0.1% ointment) were not useful. 2 Two theories underlie the efficacy of heparin and tetracycline: toxin binding and calcium chelation. The fact that the basic cardiotoxin is readily bound to the acidic sites in the tetracycline molecule and similar electrostatic binding occurs between heparin and cardiotoxin both render the cardiotoxin inactive.…”

Section: Discussionmentioning

confidence: 99%

“…Although many species of cobras are (a) able to spit to some degree and snake handlers often wear eye protective equipment on duty, the association of the venom's eye toxicity with the snake's spitting ability may account for the predominance of reports of topical ocular envenomation in connection with 'spitting' species, such as Naja nigricollis, Naja mossambica and Hemachatus haemachatus in Africa as well as Naja sumatrana and Naja atra in Asia. [1][2][3][4] The basic cardiotoxin in cobra venom is, in large part, the toxin responsible for the ocular toxicity. Another toxin in cobra venom, phospholipase A 2 , works synergistically with the cardiotoxin but phospholipase A 2 alone is free from visible ocular effects.…”

Section: Discussionmentioning

confidence: 99%

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Ophthalmic Injuries from a Spitting Chinese Cobra

Fung¹,

Choy²,

Lau³

et al. 2009

Hong Kong Journal of Emergency Medicine

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A man sustained conjunctivitis of the left eye after being spat by the venom of a Chinese cobra (Naja atra). He received fluid irrigation, topical antibiotic and topical steroid treatment. The conjunctivitis resolved without sequalae after 4 days. Various treatment options are discussed. (Hong Kong j.emerg.med. 2009;16:26-28) Keywords: Conjunctivitis, eye injuries, Naja atra, snakes, venom CaseIn August 2007, a 56-year-old man with chronic blurred vision of the left eye was spat by the venom of a Chinese cobra (Naja atra) into the left eye at a two feet distance while he was kneeling down to clean up objects outside his home. He experienced immediate pain but no subjective deterioration of the left eye vision. Irrigation with large quantity of water was performed at scene. He attended the emergency department 30 minutes post-injur y. Marked conjunctival injection was noted. Visual acuity was 20/20 on the right eye and 20/70 on the left eye. There was no photophobia, blepharospasm, iritis or pupil asymmetry. Fluorescent staining and slit-lamp examination did not reveal evidence of corneal or anterior chamber damage.Copious saline irrigation was commenced followed by instillation of topical antibiotic solution containing polymyxin, neomycin and gramicidin. At 10 hours post-injury, the pain steadily reduced to 20% of the initial level and the visual acuity was static. He was then discharged for ophthalmology assessment on the next day when 7 days of 0.1% fluorometholone eye drop was prescribed. He was completely pain free 2 days after the venom exposure. At 4 days postenvenomation, the conjunctival injection abated leaving no consequences. DiscussionThe venom of cobra is sprayed during defence as a stream from the forward facing apertures at the tips of the fangs as a result of the forceful contraction of the masseter muscles. Although many species of cobras are

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Effects of Topical Heparin, Antivenom, Tetracycline and Dexamethasone Treatment in Corneal Injury Resulting from the Venom of the Black Spitting Cobra (Naja sumatrana), in a Rabbit Model

Abstract: Topical heparin or antivenom therapy significantly improved overall outcomes in rabbit corneas exposed to Naja sumatrana venom, compared to tetracycline, dexamethasone and controls. Heparin treatment remains efficacious up to 4 minutes delay.

Cited by 19 publications

References 5 publications

Local Antivenom Treatment for Ophthalmic Injuries Caused by a Naja atra

Local Antivenom Treatment for Ophthalmic Injuries Caused by a Naja atra

Snake venom ophthalmia

Ophthalmic Injuries from a Spitting Chinese Cobra

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