What should you do when a snake spits in your eyes? Forget about those home remedies. A simple solution is the best solution.
There are five “spitting” snakes in southern Africa – the rinkhals (Hemachatus haemachatus), the Mozambique spitting cobra (Naja mossambica), the black spitting cobra (Naja nigricincta woodi), the western barred spitting cobra – also known as the zebra cobra (Naja nigricincta nigricincta) – and, just entering Namibia from Angola and Zambia, the black-necked spitting cobra (Naja nigricollis).
All of these snakes have the ability to “spit” their venom up to 3m through the air. They perform the act by putting pressure on the venom glands and forcing the venom through the fangs. The small exit hole in the bottom of the fangs is angled forward, as opposed to being angled downwards as in other venomous snakes.
When spitting, the snake aims at the target’s eyes and can be very accurate. There is evidence that if a snake spits at you while you are moving, it will anticipate your movement and spit ahead of you so that the venom still gets into your eyes. When spat at, you will usually get venom in your eyes, face, chest and arms, but it only does damage to the eyes. The rest of the venom can simply be washed off with water.
Venom in the eyes is extremely painful, and feels as though sand mixed with something like petrol is in your eyes.
In my new book, Snakes and Snakebite in Southern Africa, I recommend the following:
¥ Immediately flush the venom from the eyes with running water.
¥ Place the victim’s head under a running tap and keep it there for 15-20 minutes,
holding the eyes open and flushing out as much of the venom as possible.
¥ Take the victim to a doctor who can prescribe anti-inflammatory eye drops and run tests to assess the extent of the damage.
¥ If there is no access to water, then milk, beer, cold drink or even urine can be used, but water works best. There is no evidence that milk is more effective than water.
¥ In most instances, the eyes recover fully within a few days, and cases of permanent damage are quite rare.
Most doctors will use medicine such as chloramphenicol, a broad-spectrum antibiotic cream, which is inexpensive and widely used in the developing world.
When it comes to the eyes, the treatment and effect of venom is exactly the same in animals as in humans, though it is worth noting that dogs seem to suffer particularly badly when they get venom in their eyes.
The late Roger Blaylock, in the book Snakes of Zimbabwe and Botswana, mentioned that doctors sometimes used local anaesthetic eye drops on a single occasion to overcome pain. After the application of the antibiotic ointment, most victims recovered within 24-48 hours. He says that anti-venom or steroids are unnecessary, and that home remedies often make matters worse.
A recent debate was triggered in social media when it was recommended that, for venom a dog’s eyes, they should be washed in milk, followed by tea bags being placed over the eyes, as the tannin was said to neutralise the venom. It sounded like a snake-oil story to me, so I approached Dr Colin Tilbury and Prof Andrew Leisewitz for their comments. Colin is one of the most experienced snakebite doctors in Africa, while Andrew works at Onderstepoort Animal Hospital, where he regularly deals with snakes bites and venom attacks on animals.
Colin said: “Water is definitely the number one choice – free-flowing over the eyes for 20 minutes. There is no evidence that urine or tea bags have any benefit. I can tell you that urine squirted into a normal eye is painful, so I cannot imagine what it would do to an inflamed eye. Urine should only be used if nothing else is available.”
Andrew said: “There is no evidence that I am aware of that tea bags, milk, urine (or anything else for that matter) is more beneficial than a good rinse of the cornea. The best option would be an isotonic fluid, so I recommend that a one-litre bag of Ringers lactate or saline be used in each eye under some pressure.
“I normally cut the nipple where the IV line would be inserted, and then squeeze the bag into the eye. This course of action is really painful, so heavy sedation may be necessary.
“Sometimes there is such severe swelling of the membranous structures immediately around the eye that you cannot actually see the cornea. If this is the case, I suggest general anaesthesia so that the eye can be forcibly opened for the rinsing to take place.”
An antibiotic ointment on the eye is never a bad idea. Avoid applying steroids to the eye as the cornea is usually very badly ulcerated, and steroids will not help the healing. Systemic steroids (a short course of three days or so) can help with pain and swelling.
Washing the venom out of the eye is very important. If an isotonic fluid is not available, water is the next best thing. If water is not available, then any non-irritating fluid should be used.
The cornea is a very resilient organ and healing is usually complete.
So there you have it – forget about milk, urine, tea bags and home remedies. Fifteen to 20 minutes under a tap is best, or if you have access to Ringer’s lactate or saline, use that.
I have had snake venom in my eyes on many occasions, and have never had any serious complications.