title: 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.
abstract: BACKGROUND
  The Naja sumatrana cobra can spit venom in defense and may result in permanent blindness. The study sought to determine the efficacy of topical heparin, Haffkine antivenom, tetracycline and dexamethasone.
  
  
  METHODS
  Male New Zealand White Rabbits were used. Pooled venom was frozen at -30 degrees C. 0.05 mL of 20 times dilute venom was introduced into the conjunctiva, in groups of three rabbits randomly. Heparin at 5000 IU/mL, Haffkine antivenom or saline control was administered repeatedly on each rabbit's eye over 158 minutes, after a specified delay. In other groups, 1% tetracycline, 0.1% dexamethasone or a placebo ointment was applied and repeated at 24 and 48 hours. All the rabbits were assessed after 24, 48, 72 hours, one and two weeks by an ophthalmologist blinded to the treatment arms.
  
  
  METHODS
  Following ocular envenomation, there was immediate blepharospasm, lacrimal secretions, redness and chemosis; more intense in the normal saline group. The Roper-Hall grades improved, corneas re-epithelialized and inflammation quietened in the heparin and antivenom-treated rabbit eyes compared to controls. Scarring appeared from the first week, but ameliorated in the heparin and antivenom groups. Heparin treatment remained efficacious up to four minutes delay. The tetracycline, dexamethasone and placebo groups had worsening Roper-Hall trends, greater corneal epithelial loss, inflammation and scarring. Combined heparin-tetracycline therapy was as efficacious with heparin alone.
  
  
  CONCLUSIONS
  Topical heparin or antivenom therapy significantly improved overall outcomes in rabbit corneas exposed to Naja sumatrana venom, compared to tetracycline, dexamethasone and controls. Heparin treatment remains efficacious up to 4 minutes delay.
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, Singapore. Gregory_Cham@ttsh.com.sg
authors.forename: Gregory
authors.initials: G
authors.lastname: Cham
authors.forename: James Chuan-Hsin
authors.initials: JC
authors.lastname: Pan
authors.forename: Francis
authors.initials: F
authors.lastname: Lim
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: P
authors.initials: P
authors.lastname: Gopalakrishnakone
mesh_terms: D000287:Administration, Topical; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004195:Disease Models, Animal; D004546:Elapid Venoms / Q000633:toxicity*; D017815:Elapidae; D005128:Eye Diseases / Q000139:chemically induced / Q000188:drug therapy*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009824:Ointments; D011817:Rabbits; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000997:Antivenins; D004546:Elapid Venoms; D009824:Ointments; D003907:Dexamethasone; D006493:Heparin; D013752:Tetracycline