Ophthalmology · Ocular Trauma and Emergencies (Chemical Burns, Open Globe, Endophthalmitis)

A patient presents one day after a penetrating corneal injury repaired elsewhere. Slit-lamp examination is performed with 2% fluorescein and cobalt blue illumination. A dark rivulet is seen streaming through an otherwise uniform orange pool. What does this finding indicate?

  • A Corneal epithelial defect only
  • B Seidel-positive sign: full-thickness wound leak
  • C Corneal stromal oedema
  • D Band keratopathy
Correct answer: B. Seidel-positive sign: full-thickness wound leak

Explanation

The Seidel test is positive when fluorescein is diluted by leaking aqueous humour, producing a dark stream within the orange dye under cobalt blue light. It confirms a full-thickness corneal or scleral wound with active aqueous leak, even if the wound appears sealed clinically. It is a key sign in suspected occult globe rupture.

Reference: AAO BCSC Section 8: External Disease and Cornea, 2023-2024 ed.

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