Ocular toxicity associated with indirect exposure to African spitting cobra venom.

Direct ocular inoculation with African spitting cobra (Naja nigricollis) venom in the United States is uncommon, especially in an urban setting, but can lead to serious acute and chronic ocular injury depending on the extent of exposure. We report 2 cases of indirect ocular inoculation with venom from an African spitting cobra, manifesting as periocular soft tissue swelling, extensive conjunctivitis, and corneal epithelial erosion. Both of the reported cases involve young male patients who received prompt emergency evaluation and treatment including copious irrigation of the ocular surface, followed by close monitoring by an ophthalmologist resulting in excellent outcomes with minimal visually significant ocular sequelae.