A 49-Year-Old Male Private Snake Keeper With Venom-Spit Ophthalmia

At 72 hours after injury, the patient was asymptomatic, his visual acuity was improved, and results of the slit-lamp examination were negative. Because the venom also contains enzymes, ocular damage is increased with prolonged contact. Decontamination is the mainstay of treatment, and the eyes should immediately be continuously irrigated with copious amounts of water or saline solution.1-6 Application of soothing liquids, such as milk or even beer, in the eyes have been reported to provide some relief, but are not recommended as the standard of care.1,2,5 A detailed examination of the affected eyes should include testing for visual acuity, intraocular pressure, and slit-lamp examination with fluorescein staining to assess corneal damage. Prophylactic antibiotic drops (eg, ciprofloxacin) should be instilled to prevent secondary keratitis and infection in the presence of corneal injury.1-6 Tetracycline ophthalmic ointment has been shown to bind with the cardiotoxins, rendering them inactive and reducing the extent of corneal scarring.1,3-5 The use of topical corticosteroids is not recommended because of possible increased corneal damage caused by enhanced collagenase activity during administration.1-3 The use of intravenous antivenin has no role in treatment in the absence of systemic envenomation, and ophthalmic instillation of antivenin may cause increased local irritation and is contraindicated.1-3,5,6 Discharge instructions should include information on eye protection, administration of medication, and referral to ophthalmology for follow-up.