{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:10:03Z","timestamp":1756314603491,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,3,9]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>We present a case of cobra venom keratoconjunctivitis, an ocular injury caused by a snake\u2019s defensive mechanism of spitting venom into a predator\u2019s eyes. A male in his 50s reported to the outpatient department of a regional hospital in Songea, Tanzania, with 24 hours of eye pain, photophobia and decreased vision after being sprayed in the face by a cobra. The affected eye was anaesthetised with topical tetracaine hydrochloride 0.5% and irrigated with 1\u2009L of lactated Ringer\u2019s solution. Tetracycline hydrochloride 1% ophthalmic ointment was placed in the inferior sulcus, and the lid was taped shut for 24 hours. The patient was instructed to apply the antibiotic ointment two times per day and to follow-up in 48 hours. At the follow-up visit, the patient reported a reduction in pain within 24 hours. Although his vision remained blurry, the pain had diminished. Several weeks later, the patient\u2019s vision had returned to baseline.<\/jats:p>","DOI":"10.1136\/bcr-2024-263975","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T04:15:28Z","timestamp":1745554528000},"page":"e263975","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cobra venom keratoconjunctivitis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7986-1220","authenticated-orcid":false,"given":"Rita Sofia","family":"Glazer","sequence":"first","affiliation":[{"name":"Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Durcan","sequence":"additional","affiliation":[{"name":"Director, Eye Corps Inc, Salt Lake City, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1751-9709","authenticated-orcid":false,"given":"Susan","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles Peter","family":"Hinju","sequence":"additional","affiliation":[{"name":"Ruvuma Regional Referral Hospital, Songea, Tanzania, United Republic of"},{"name":"Eye Corps Inc, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"2025082709323128000_18.4.e263975.1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/j.1469-7998.1995.tb02743.x","article-title":"On the \u2018spitting\u2019 behaviour in cobras (Serpentes: Elapidae)","volume":"237","author":"Rasmussen","year":"1995","journal-title":"J Zool (Lond)"},{"key":"2025082709323128000_18.4.e263975.2","doi-asserted-by":"crossref","DOI":"10.3390\/toxins15070468","article-title":"A Retrospective Cohort Study of Cobra Envenomation: Clinical Characteristics, Treatments, and Outcomes","volume":"15","author":"Tansuwannarat","year":"2023","journal-title":"Toxins (Basel)"},{"key":"2025082709323128000_18.4.e263975.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00359-005-0010-8"},{"key":"2025082709323128000_18.4.e263975.4","doi-asserted-by":"publisher","DOI":"10.1242\/jeb.037135"},{"key":"2025082709323128000_18.4.e263975.5","unstructured":"Healio . Early management of snake venom ophthalmia leads to fast recovery. Healio; 2022. Available: https:\/\/www.healio.com\/news\/ophthalmology\/20220203\/early-management-of-snake-venom-ophthalmia-leads-to-fast-recovery"},{"key":"2025082709323128000_18.4.e263975.6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.4103\/0974-9233.134689","article-title":"Ophthalmia due to spitting cobra venom in an urban setting--a report of three cases","volume":"21","author":"Ang","year":"2014","journal-title":"Middle East Afr J Ophthalmol"},{"key":"2025082709323128000_18.4.e263975.7","first-page":"5","article-title":"Snake venom ophthalmia: a review","volume":"16","author":"Ghosh","year":"2009","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2025082709323128000_18.4.e263975.8","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.ijbiomac.2017.12.101","article-title":"An overview of the immune modulating effects of enzymatic toxins from snake venoms","volume":"109","author":"Burin","year":"2018","journal-title":"Int J Biol Macromol"},{"key":"2025082709323128000_18.4.e263975.9","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3109\/15563658608990457","article-title":"Ocular effects of the venom from the spitting cobra (Naja nigricollis)","volume":"24","author":"Ismail","year":"1986","journal-title":"J Toxicol Clin Toxicol"},{"key":"2025082709323128000_18.4.e263975.10","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1007\/BF02174059","article-title":"Experimental studies on the spitting cobra ophthalmia (Naja nigricollis)","volume":"223","author":"Gr\u00fcntzig","year":"1985","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2025082709323128000_18.4.e263975.11","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1976.25.525"},{"key":"2025082709323128000_18.4.e263975.12","doi-asserted-by":"crossref","DOI":"10.3390\/toxins12090576","article-title":"Venom Ophthalmia and Ocular Complications Caused by Snake Venom","volume":"12","author":"Chang","year":"2020","journal-title":"Toxins (Basel)"},{"key":"2025082709323128000_18.4.e263975.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2010.02.023"},{"key":"2025082709323128000_18.4.e263975.14","first-page":"141","article-title":"Blindness from spitting cobra venom: case report","volume":"93","author":"Atipo-Tsiba","year":"2016","journal-title":"East Afr Med J"},{"key":"2025082709323128000_18.4.e263975.15","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.4269\/ajtmh.23-0374","article-title":"Case Report: Snake Venom Ophthalmia Caused by Cobra Exposure: A Report of 26 Cases","volume":"109","author":"Zhang","year":"2023","journal-title":"Am J Trop Med Hyg"},{"key":"2025082709323128000_18.4.e263975.16","first-page":"5","article-title":"Snake venom ophthalmia: a review","volume":"16","author":"Ghosh","year":"2009","journal-title":"Asia Pac J Ophthalmol (Phila)"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263975","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:32:39Z","timestamp":1756312359000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263975"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,24]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bcr-2024-263975"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263975","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}