Local Antivenom Treatment for Ophthalmic Injuries Caused by a Naja atra

Abstract

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.

Venom Ophthalmia and Ocular Complications Caused by Snake Venom

“…They observed that cobras perform rapid cephalic oscillations to coordinate the target’s movements, for increasing the chance of hitting the eyes. Due to high occurrences of venom spitting on the eye, we review cases of venom-spit ophthalmia by cobras in Asia [ 3 , 9 , 10 ], Africa [ 3 ], and United States [ 11 ] as well as by rattlesnakes in the United States [ 12 , 13 , 14 ] ( Table 1 ).…”

“…Although no children were reported in Taiwan, snake venom spitting was also considered one of the causes of eye burn in children in other courtiers [ 15 ]. Another venom-spit ophthalmia by N. atra was reported from an 83-year-old woman in Hong Kong while she was trying to kill the cobra [ 9 ]. After being treated with 0.5% chloramphenicol and 0.12% prednisolone eye drops, she went home without severe symptoms.…”

Ocular complications of spitting cobra venom

“…Also, diluted antivenom was instilled in her eyes, which interestingly gave a substantial pain reduction. [ 16 ] One herpetologist has been spat in the same eye by three different types of captive spitting cobra ( H. haemachatus, N. atra , and Naja pallida ) at different occasions. Direct irrigation with tap water for 1–2 h helped in all cases.…”