Lokesh Kolhe - National healthcare, Woodlands Health, Singapore.
Adeline NGO - National healthcare, Woodlands Health, Singapore.
Kee Vooi Loo - Department of emergency medicine, Ng Teng Fong General Hospital, Singapore.
Gregory Cham - Department of emergency medicine, Ng Teng Fong General Hospital, Singapore.

Background: Venom ophthalmia (VO) is caused by inoculation of venom in the eyes. In Singapore, the spitting cobra is associated with VO. We present ۲ cases of VO treated with topical heparin despite not proven for clinical use.Case Report: Our first patient was spat by a spitting cobra in his eye while working and complained of throbbing pain and blurring of vision. He irrigated his eyes with drinking water before attending the Emergency Department (ED). His pain and vision minimally improved despite irrigation with normal saline. ۱ml of unfractionated Heparin (UFH) resulted in improvement of pain.Our second patient was spat by a spitting cobra in his right eye, had right eye pain and tearing. He had irrigated the eye with water before coming to the ED. In ED, his eye was irrigated with ۹.۵L of normal saline followed by ۱ ml of UFH.Both were reviewed by Ophthalmology and showed punctate epithelial erosions (PEE), which resolved ۲ weeks after for the first patient. Unfortunately, the second patient defaulted his follow up. However, none showed immediate side effect after UFH.Discussion: Multiple anterior segment complications have been reported in cases of VO. Copious irrigation of the eyes with water or saline is single most important step in management. Heparin has not been described to be a part of standard treatment protocol.Conclusion: Topical heparin drops may safely be used in cases of VO, where traditional irrigation methods do not result in improvement in symptoms.

Spitting Cobra, Naja Sumatrana, Topical Heparin