title: Toxin ophthalmia caused by nuchal gland secretion of the Taiwan tiger keelback (Rhabdophis tigrinus formosanus).
abstract: Rhabdophis tigrinus is a common colubrid snake that can be found in an extensive geographical region in East Asia. It consists of two subspecies: R.t. tigrinus (yamakagashi) and R.t. formosanus (Taiwan tiger keelback). R. tigrinus possesses two different sets of poisonous glands: the Duvernoy's glands in the maxilla, and the nuchal glands in the dorsal skin of the neck. We report the first case in current English literature of toxin ophthalmia caused by the nuchal gland secretion of R.t. formosanus. The patient was a 40-year-old man whose right eye was sprayed by the nuchal gland fluid of R.t. formosanus. He presented with symptoms of foreign body sensation, progressive burning pain, and blurred vision. Ophthalmologic examination revealed diffuse superficial punctate keratitis, corneal stromal edema with Descemet folds, and conjunctival congestion. The patient responded well to topical treatment with a corticosteroid, antihistamine, and antibiotic, and had a favorable clinical course and outcome.
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan; Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: Yen-Chia
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.affiliation: Department of Respiratory Therapy, Taipei Veterans General Hospital, Taipei City, Taiwan; School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan; School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: Mu-Shung
authors.initials: MS
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
authors.forename: Chun-I
authors.initials: CI
authors.lastname: Huang
authors.affiliation: Center for Drug Evaluation, Taipei City, Taiwan; West Garden Hospital, Taipei City, Taiwan. Electronic address: chen.minhui@gmail.com.
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000818:Animals; D017812:Colubridae; D009877:Endophthalmitis / Q000209:etiology*; D006801:Humans; D008297:Male; D012910:Snake Venoms / Q000633:toxicity*; D013624:Taiwan
chemical_list: D012910:Snake Venoms
keywords: Rhabdophis tigrinus; Taiwan tiger keelback; colubrid snake; eye injury; nuchal gland; ophthalmia