Experimental studies on the spitting cobra ophthalmia (Naja nigricollis)

Venom Ophthalmia and Ocular Complications Caused by Snake Venom

Little is known about the detailed clinical description, pathophysiology, and efficacy of treatments for ocular envenoming (venom ophthalmia) caused by venom of the spitting elapid and other snakes, as well as ocular complications caused by snake venom injection. In this paper, we review clinical information of case reports regarding venom ophthalmia and snake venom injection with associated ocular injuries in Asia, Africa, and the United States. We also review the literature of snake venom such as their compositions, properties, and toxic effects. Based on the available clinical information and animal studies, we further discuss possible mechanisms of venom ophthalmia derived from two different routes (Duvernoy's gland in the mouth and nuchal gland in the dorsal neck) and the pathophysiology of snake venom injection induced ocular complications, including corneal edema, corneal erosion, cataract, ocular inflammation, retinal hemorrhage, acute angle closure glaucoma, as well as ptosis, diplopia, and photophobia. Finally, we discuss the appropriate first aid and novel strategies for treating venom ophthalmia and snake envenoming.

The Ex vivo Eye Irritation Test (EVEIT) model as a mean of improving venom ophthalmia understanding

Snakes belonging to the genus Naja (Elapid family), also known as "spitting cobras", can spit venom towards the eyes of the predator as a defensive strategy, causing painful and potentially blinding ocular envenoming. Venom ophthalmia is characterized by pain, hyperemia, blepharitis, blepharospasm and corneal erosions. Elapid venom ophthalmia is not well documented and no specific treatment exists. Furthermore, accidental ejection of venom by non-spitting vipers, as Bothrops, also occurs. The Ex vivo Eye Irritation Test model (EVEIT) has enabled important progress in the knowledge of chemical ocular burns. Considering the lack of experimental animal model, we adapted the EVEIT to study venom ophthalmia mechanisms. Ex vivo rabbit corneas were exposed to venoms from spitting (Naja mossambica, Naja nigricollis) and non-spitting (Naja naja, Bothrops jararaca and Bothrops lanceolatus) snakes, and rinsed or not with water. The corneal thickness and the depth of damage were assessed using high-resolution optical coherence tomography (HR-OCT) imaging and histological analysis. All Naja venoms induced significant corneal edema, collagen structure disorganization and epithelial necrosis. Corneas envenomed by African N. mossambica and N. nigricollis venoms were completely opaque. Opacification was not observed in corneas treated with venoms from non-spitting snakes, such as the Asian cobra, N. naja, and the vipers, B. jararaca and B. lanceolatus. Moreover, Bothrops venoms were able to damage the epithelium and cause collagen structure disorganization, but not edema. Immediate water rinsing improved corneal status, though damage and edema could still be observed. In conclusion, the present study shows that the EVEIT model was successfully adapted to set a new experimental ex vivo animal model of ophthalmia, caused by snake venoms, which will enable to explore new therapies for venom ophthalmia.

Potential targets aimed at by spitting cobras when deterring predators from attacking

When threatened, spitting cobras eject venom towards the face of an aggressor. To uncover the relevant cues used by cobras for face recognition we determined how often artificial targets equipped with or without eyes elicited spitting behavior. In addition, we measured whether and how target shape and size influenced the spitting behavior of cobras. Results show that oval- and round-shaped targets were most effective, while triangles with the same surface area as oval 'face like' targets hardly elicited spitting. The likelihood of spitting depended on neither the presence, the spatial arrangement (horizontal or vertical) nor the surface texture (shiny or matt) of glass eyes. Most likely, cobras do not specifically aim at the eyes of an offender but at the center of the body part closest to them. As this is usually the face of an animal, this strategy will result in at least one eye of the offender being hit most of the time.

The ocular effects of spitting cobras: I. The ringhals cobra (Hemachatus haemachatus) venom-induced corneal opacification syndrome

Venom from the ringhals cobra (H. haemachatus) caused extensive chemosis, prolonged corneal edema and marked miosis when applied locally to the eyes of two strains of rabbits: Buskat (albino) and Chinchilla (pigmented). In the pigmented rabbits, the corneal edema progressed to complete corneal opacification with corneal and conjunctival neovascularization that remained unchanged until the end of the experiment (70 d). In the albino rabbits the corneal cloudiness and conjunctivitis cleared within three weeks of venom instillation. Treatment with heparin and tetracycline markedly improved the corneal opacification syndrome, while treatment with specific antivenom resulted only in partial improvement. It is postulated that the venom owes its ocular effects to its cardiotoxin, the only venom fraction capable of inducing the corneal opacification syndrome. The protective effect of heparin is probably through its electrostatic binding to the cardiotoxin in the venom. Tetracycline could form ionic bonding at several sites in the strongly basic cardiotoxin. The corneal opacification syndrome was associated with the ability of the snakes to spit since venoms from the other non-spitting cobras were devoid of this activity.