We read with interest the article entitled “Ophthalmic Exposure to Crotalid Venom,”
which presented the first reported case involving the use of intravenous (i.v.) antivenom
(CroFab®; BTG International Inc., West Conshohocken, PA) in the management of pit
viper ocular accidental contact irritation (
1
). Virtually all published experience with snake venom ophthalmia relates to spitting
cobras (family Elapidae), where both fangs and venom have evolved to specifically target the eye, yet there
is no evidence that this results in systemic envenoming, the prime indication for
antivenom therapy. In spitting cobra-induced ocular envenoming, antivenom has been
used only topically, but the most current published expert advice does not recommend
this treatment (
2
,
3
). With this background, the use of i.v. antivenom in the Johnson case is puzzling
and difficult to support.To read this article in full you will need to make a payment
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References
- Ophthalmic exposure to crotalid venom.J Emerg Med. 2009; 36: 37-38
- Management of cobra spit ophthalmia.in: Warrell D.A. Guidelines for the clinical management of snake bite in the South-East Asia Region. 49. World Health Organization, Regional Office for South-East Asia, New Delhi, India2005
- Clinical toxicology of snakebite in Asia.in: Meier J. White J. Handbook of clinical toxicology of animal venoms and poisons. Informa HealthCare, Boca Raton, FL1995: 579-618
- Envenomations: an overview of clinical toxinology for the primary care physician.Am Fam Physician. 2009; 80: 793-802
- North American snake envenomation: diagnosis, treatment and management.Emerg Med Clin North Am. 2004; 22: 423-443
- Snakebite: a brief medical guide.White, Stirling, South Australia2007
- Immediate and delayed allergic reactions to Crotalidae polyvalent immune Fab (ovine) antivenom.Ann Emerg Med. 2002; 39: 671-676
- Efficacy, safety, and use of snake antivenoms in the United States.Ann Emerg Med. 2001; 37: 181-188
- Acute hypersensitivity reactions associated with administration of crotalidae polyvalent immune Fab antivenom.Ann Emerg Med. 2008; 51: 407-411
- Snake venom ophthalmia and blindness caused by the spitting cobra (Naja nigricollis) in Nigeria.Am J Trop Med Hyg. 1976; 25: 525-529
- Ocular exposure to rattlesnake venom.J Toxicol Clin Toxicol. 2003; 41: 605-606
- Topical ophthalmic exposure to rattlesnake venom.Am J Emerg Med. 1989; 7: 307-308
Article info
Publication history
Published online: December 14, 2009
Identification
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© 2010 Published by Elsevier Inc. All rights reserved.
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- Ophthalmic Exposure to Crotalid VenomJournal of Emergency MedicineVol. 36Issue 1
- Response to Drs. Chu, White, and WeinsteinJournal of Emergency MedicineVol. 39Issue 5
- PreviewI appreciate Drs. Chu, White, and Weinstein's interest in my article, “Ophthalmic Exposure to Crotalid Venom” (1). Their comments are not only complete but also give a brief overview of the treatment of crotalid envenomation and describe what is thought to be the standard of care for crotalid ocular envenomations.
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