https://doi.org/10.4081/ecj.2026.15200
Ocular envenomation by the equatorial spitting cobra: a case report and review of venom ophthalmia associated with Naja species
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 7 July 2026
Snake venom ophthalmia is a rare and potentially blinding condition caused by the defensive projection of venom into the eyes by certain elapids, such as Naja species. While primarily a public health concern in tropical regions, its incidence is rising in Western countries due to the increasing popularity of exotic pet ownership and risks inherent in animal research. Despite the well-characterized systemic effects of Naja bites, significant gaps remain in the literature regarding the clinical course, optimal management strategies, and long-term visual outcomes of venom ophthalmia. We report a paediatric case of venom ophthalmia following direct ocular exposure to venom projected by the Equatorial spitting cobra (Naja sumatrana), accompanied by a brief review of the existing literature.
Downloads
[1] Chang KC, Huang YK, Chen YW, et al. Venom Ophthalmia and Ocular Complications Caused by Snake Venom. Toxins (Basel) 2020;12:576. DOI: https://doi.org/10.3390/toxins12090576
[2] Pugh RN, Theakston RD, Reid HA. Malumfashi Endemic Diseases Research Project, XIII. Epidemiology of human encounters with the spitting cobra, Naja nigricollis, in the Malumfashi area of northern Nigeria. Ann Trop Med Parasitol 1980:74:523e530. DOI: https://doi.org/10.1080/00034983.1980.11687380
[3] Ang LJ, Sanjay S, Sangtam T. Ophthalmia due to spitting cobra venom in an urban setting: a report of three cases. Middle East Afr J Ophthalmol 2014;21:259-61. DOI: https://doi.org/10.4103/0974-9233.134689
[4] Zhang Z, Yang J, Fang J, et al. Case report: snake venom ophthalmia caused by cobra exposure: a report of 26 cases. Am J Trop Med Hyg 2023;109:1393-6. DOI: https://doi.org/10.4269/ajtmh.23-0374
[5] Fung HT, Lam KK, Wong OF. Local antivenom treatment for ophthalmic injuries caused by a Naja atra. J Med Toxicol 2010;6:147–9. DOI: https://doi.org/10.1007/s13181-010-0068-8
[6] Lanzetta MA, Cirtita M, Aziebu E, et al. Ophthalmia secondary to cobra venom spitting in the Volta Region, Ghana: a case report. Case Rep Ophthalmol 2017;8:99-103. DOI: https://doi.org/10.1159/000458519
[7] Handford C. Case of venom ophthalmia following contact with Naja pallida: the red spitting cobra. J R Army Med Corps 2018;164:124-6. DOI: https://doi.org/10.1136/jramc-2017-000891
[8] Goldman DR, Seefeld AW. Ocular toxicity associated with indirect exposure to African spitting cobra venom. Wilderness Environ Med 2010;21:134-6. DOI: https://doi.org/10.1016/j.wem.2009.12.007
[9] Chu ER, Weinstein SA, White J, Warrell DA. Venom ophthalmia caused by venoms of spitting elapid and other snakes: Report of ten cases with review of epidemiology, clinical features, pathophysiology and management. Toxicon 2010;56:259–72. DOI: https://doi.org/10.1016/j.toxicon.2010.02.023
[10] Sharma VK, Baranwal VK. Snake venom ophthalmia. Med J Armed Forces India 2015 ul;71:S197-8. DOI: https://doi.org/10.1016/j.mjafi.2014.01.003
[11] Warrell DA. In: Guidelines for the Management of Snake-bites: Management of Cobra Spit Ophthalmia. WHO Library Cataloguing-in-Publication Data; 2010:123e124.
[12] Ministry of Health, Malaysia. Guideline Management of Snake Bite. 2017. Available from: https://www.mybis.gov.my/pb/1548.
[13] Cham G, Pan JC, Lim F, et al. Effects of topical heparin, antivenom, tetracycline and dexamethasone treatment in corneal injury resulting from the venom of the black spitting cobra (Naja sumatrana), in a rabbit model. Clin Toxicol (Phila) 2006;44:287-92. DOI: https://doi.org/10.1080/15563650600584451
CRediT authorship contribution
All authors made substantial contributions. Muhammad Khidir Mohd Kamil, conceptualization, supervision, writing‒original draft preparation, writing‒reviewing and editing; Pradeep Gupta Niriender Kumar, data curation, writing‒original draft preparation; Ruth Sabrina Safferi, conceptualization, supervision, writing‒reviewing and editing; Vishel Soundarajan, writing- original draft preparation, writing- reviewing and editing; Nor Ain Izzati Nor Azlan, data curation, writing- original draft preparation.
Supporting Agencies
Data Availability Statement
All data generated or analyzed during this study are included in this published article.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
