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

Abstract

Purpose: To report the first case of ophthalmia due to contact with cobra venom in the Volta Region, Ghana. Methods: An ointment containing vitamin A was applied to treat the patient’s unilateral defects in the corneal epithelium and the consequent diminished visual acuity. Results: Healing of the corneal epithelium and improvement of visual acuity were observed after only 1 day. Conclusions: This case suggests that consequences of cases of cobra venom spitting in the eyes can be minimal if immediate treatment is provided.

Review of the Mechanisms of Snake Venom Induced Pain: It’s All about Location, Location, Location

“…Venom mediated eye pain (venom ophthalmia) has been extensively reported after various Naja species (spitting cobras) project their venom into their victim's eyes [17][18][19][20][21][22][23] or after systemic envenomation by Atractaspis snake bite on rare occasion (remote, direct mechanism) [10]. In the case of Atractaspis envenomation, the eye pain occurred when the eyes moved, but no true ophthalmia was observed, and symptoms abated over time without any specific treatment [10]-thus, it is difficult to speculate what molecular mechanisms were at play.…”

“…Eye pain would be expected following ocular exposure to venom, given the presence of preformed compounds that inflict pain (see Section 2.2). Further, the enzymatic action of PLA 2 and other enzymes on the cell membranes of the cornea and conjunctiva would be expected to amplify venom mediated pain and inflict edema and tissue injury as reported [17][18][19][20][21][22][23][24][25]. Of interest, Asian and African spitting cobras appear to have a greater percentage of PLA 2 in their venom than do the corresponding non-spitting cobra species; further, it appears that the African spitting cobras have a greater percentage of cytotoxic 3-finger toxins in their venom than the Asian spitting cobras [28].…”

“…Of interest, Asian and African spitting cobras appear to have a greater percentage of PLA 2 in their venom than do the corresponding non-spitting cobra species; further, it appears that the African spitting cobras have a greater percentage of cytotoxic 3-finger toxins in their venom than the Asian spitting cobras [28]. In general, venom ophthalmia has been treated successfully with local interventions: flushing with water, and administering a variety of medications including local anesthetics, antibiotics, antihistamines, steroids, and occasionally antivenom eye drops [17][18][19][20][21][22][23][24][25]. Interestingly, antivenom administered locally or systemically has not been demonstrated to be superior to non-specific treatments alone [26].…”

“…However, in the maelstrom of this event, the cause and nature of the painful experience associated with envenomation may be as varied as the biochemical and proteomic composition of the venom [1][2][3] to which the bitten are exposed. Acute local pain [4,5] can spread systemically, experienced as headache [6][7][8][9][10][11][12][13][14][15][16], eye pain [17][18][19][20][21][22][23][24][25][26][27][28], chest pain [27][28][29][30][31][32][33][34], focal back pain [34,35], abdominal pain [5,33,[36][37][38][39][40][41][42][43][44][45][46...…”

Ocular complications of spitting cobra venom

“…[ 12 ] A Ghanese farmer sustained diffuse punctate corneal epithelial defects which healed completely after irrigation and vitamin A ointment. [ 13 ] Four (bilateral) cases of venom ophthalmia were reported in UN soldiers, stationed in Somalia. All eyes were irrigated immediately.…”