Letter to the Editor| Volume 39, ISSUE 5, P659-660, November 2010

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Is There Any Role for Intravenous Antivenom for Snake Venom Ophthalmia?

Published:December 14, 2009DOI:
      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 (
      • Johnson R.
      Ophthalmic exposure to crotalid venom.
      ). 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 (
      • Warrell D.A.
      Management of cobra spit ophthalmia.
      • Warrell D.A.
      Clinical toxicology of snakebite in Asia.
      ). With this background, the use of i.v. antivenom in the Johnson case is puzzling and difficult to support.
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        Ophthalmic exposure to crotalid venom.
        J Emerg Med. 2009; 36: 37-38
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        Clinical toxicology of snakebite in Asia.
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      Linked Article

      • Ophthalmic Exposure to Crotalid Venom
        Journal of Emergency MedicineVol. 36Issue 1
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          Crotalid venom exposure to the eye is uncommon. A 40-year-old woman sustained an accidental mucus membrane exposure of rattlesnake venom to her face and right eye. She was successfully treated with irrigation, topical antibiotics, and intravenous crotalid antivenin.
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      • Response to Drs. Chu, White, and Weinstein
        Journal of Emergency MedicineVol. 39Issue 5
        • Preview
          I 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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