Emergency medical care is essential in preventing morbidity and mortality, especially when interventions are time-sensitive and require immediate access to supplies and trained personnel.

To assess the treatment rates of eye emergencies in Africa. Ocular emergencies are particularly delicate due to the eye’s intricate structure and the necessity for its refractive components to remain transparent.

This review examines the low treatment rates of eye emergencies in Africa, drawing on 96 records extracted from the PubMed database using predetermined search criteria.

The epidemiology of ocular injuries, as detailed in the studies, reveals significant relationships between the incidence and prevalence of eye injuries and factors such as age, gender, and occupation. The causes of eye emergencies range from accidents to gender-based violence and insect or animal attacks. Management approaches reported in the review include both surgical and non-surgical interventions, from medication to evisceration or enucleation of the eye. Preventive measures emphasize eye health education and the use of protective eyewear and facial protection. However, inadequate healthcare infrastructure and personnel, cultural and geographical barriers, and socioeconomic and behavioral factors hinder the effective prevention, service uptake, and management of eye emergencies.

The authors recommend developing eye health policies, enhancing community engagement, improving healthcare personnel training and retention, and increasing funding for eye care programs as solutions to address the low treatment rate of eye emergencies in Africa.

• Eye emergency
• Ocular injury
• Epidemiology
• Treatment
• Africa

• basement membrane
• coagulotoxicity
• cytotoxicity
• detachment
• direct toxin inhibitors (DTIs)
• electric cell-substrate impedance sensing (ECIS)
• marimastat
• snakebite envenoming
• varespladib

• Electric Impedance
• Animals
• Feasibility Studies
• Viper Venoms/toxicity
• Elapid Venoms/toxicity
• Antivenins/pharmacology
• Blood Coagulation/drug effects
• Humans
• Phospholipases A2, Secretory/antagonists & inhibitors
• Hydroxamic Acids/pharmacology
• Snake Bites

• _1 Robert Hicks Trust
• Internal Research Funds Ophirex, Inc.

• Bangladesh
• Monocled cobra
• Naja kaouthia
• Ocular envenomation
• Safety precautions
• Spitting behavior
• Venom

• Animals
• Snake Bites/drug therapy
• Elapid Venoms/toxicity
• Elapid Venoms/poisoning
• Male
• Humans
• Eye Injuries
• Naja naja
• Elapidae

• Musk
• Ocular
• Rattlesnake
• Spitting
• Spray
• Venom

• Animals
• Arizona
• Humans
• Snake Bites
• Male
• Crotalus
• Retrospective Studies
• Female
• Crotalid Venoms/toxicity
• Adult
• Middle Aged
• Adolescent
• Aged
• Child
• Eye/drug effects
• Young Adult
• Poison Control Centers

African spitting cobras are unique among cobras for their potent anticoagulant venom activity arising from strong inhibition of Factor Xa. This anticoagulant effect is exerted by venom phospholipase A₂ (Group I PLA₂) toxins whose activity contributes to the lethality of these species. This anticoagulant toxicity is particularly problematic as it is not neutralized by current antivenoms. Previous work demonstrated this trait for Naja mossambica, N. nigricincta, N. nigricollis, and N. pallida. The present work builds upon previous research by testing across the full taxonomical range of African spitting cobras, demonstrating that N. ashei, N. katiensis, and N. nubiae are also potently anticoagulant through the inhibition of Factor Xa, and therefore the amplification of potent anticoagulant activity occurred at the base of the African spitting cobra radiation. Previous work demonstrated that the enzyme-inhibitor varespladib was able to neutralize this toxic action for N. mossambica, N. nigricincta, N. nigricollis, and N. pallida venoms. The current work demonstrates that varespladib was also able to neutralize N. ashei, N. katiensis, and N. nubiae. Thus varespladib is shown to have broad utility across the full range of African spitting cobras. In addition, we examined the cross-reactivity of the metalloprotease inhibitor prinomastat, which had been previously intriguingly indicated as being capable of neutralizing viperid venom PLA₂ (Group II PLA₂). In this study prinomastat inhibited the FXa-inhibiting PLA₂ toxins of all the African spitting cobras at the same concentration at which it has been shown to inhibit metalloproteases, and thus was comparably effective in its cross-reactivity. In addition we showed that the metalloprotease-inhibitor marimastat was also able to cross-neutralize PLA₂ but less effectively than prinomastat. Due to logistical (cold-chain requirement) and efficacy (cross-reactivity across snake species) limitations of traditional antivenoms, particularly in developing countries where snakebite is most common, these small molecule inhibitors (SMIs) might hold great promise as initial, field-based, treatments for snakebite envenoming as well as addressing fundamental limitations of antivenom in the clinical setting where certain toxin effects are unneutralized.

• Factor Xa
• anticoagulant
• enzyme
• inhibitor
• venom

The global burden of snakebites is growing, particularly its nonfatal sequelae. Therefore, the World Health Organization reinstated snakebites to its list of Neglected Tropical Diseases. We describe the case of a 4.5-year-old boy who was bitten by a spitting cobra, resulting in considerable local swelling accompanied by a right-sided facial paralysis due to neurotoxicity by cobra venom. Presently, surgical methods to recover facial paralysis include nerve repair, nerve grafting, nerve transfers, static slings, muscle transfers, and functional muscle transplantations. However, mime therapy consisting of neuromuscular retraining resulted in a good functional result with a moderate contour deficiency of the right cheek and a subtle paresis of the zygomatic muscles at 1 year and 9 months follow-up. The natural history of facial paralysis in our case shows that this condition can be transient and may resolve with mime therapy as a conservative measure.

• Facial paralysis
• Neurological rehabilitation
• Snake bites
• Venoms

• Adolescent
• Adult
• Elapid Venoms/toxicity
• Endophthalmitis/epidemiology
• Endophthalmitis/etiology
• Endophthalmitis/therapy
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Snake Bites/epidemiology
• Surveys and Questionnaires
• Taiwan/epidemiology
• Time Factors
• Young Adult

• coral snake
• envenomation
• neurotoxicity