Ophthalmia due to spitting cobra venom in an urban setting - A report of three cases

Abstract

To describe three presentations of spitting cobra venom induced ophthalmia in urban Singapore. Case notes and photographs of three patients with venom ophthalmia who presented to our clinic between 2007 and 2012 were reviewed. Two patients encountered the spitting cobra while working at a job site while the third patient had caught the snake and caged it. The venom entered the eyes in all 3 cases. Immediate irrigation with tap water was carried out before presenting to the Accident and Emergency department. All patients were treated medically with topical antibiotic prophylaxis and copious lubricants. The use of anti-venom was not required in any case. All eyes recovered with no long-term sequelae. If irrigation is initiated early, eyes can recover with no significant complications or sequelae.

Ophthalmia Secondary to Cobra Venom Spitting in the Volta Region, Ghana: A Case Report

“…Direct ocular exposure to cobra venom spitting has been reported previously in a few dozen humans [ 2 , 3 , 4 , 5 , 6 ]. Cobras spread the venom over the entire face of the aggressor by rapidly moving their head, therefore enhancing the chance of hitting at least 1 eye [ 1 ].…”

“…Cobras spread the venom over the entire face of the aggressor by rapidly moving their head, therefore enhancing the chance of hitting at least 1 eye [ 1 ]. As a consequence, various degrees of ocular and periocular injuries have been reported [ 2 , 3 , 4 , 5 , 6 ].…”

“…Although rare, this event can lead to ocular envenomation with potentially serious injuries. Reported consequences range from periocular soft tissue swelling, hyperemia, extensive conjunctivitis, and corneal epithelial erosion to corneal opacity, uveitis, and hypopion, and even cranial nerve VII involvement [ 2 , 3 , 4 , 5 , 6 ].…”

“…Previous reports have highlighted the importance of an emergency therapeutic approach with multiple drugs to avoid severe complications such as necrosis of the eye [ 3 , 6 ]. However, in most cases a strict follow-up with early observation after the trauma is not available.…”

Ocular complications of spitting cobra venom

“…Multiple corneal punctate epithelial erosions were successfully treated with prophylactic antibiotic drops. [ 17 ] In Taiwan, there were 39 reported cases from 1990 to 2016. Most symptoms were mild (59%).…”