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Description
A middle-aged man presented to the acute eye clinic during the COVID-19 pandemic complaining of a red painful left eye. This was following trauma by a shrub branch while gardening. At initial review, a partial thickness-shelved corneal laceration was surprisingly noted to be Seidel negative, despite transecting almost 90% of the corneal thickness at the deepest point (figure 1).
Slit-lamp colour image of the left eye, after application of 2% fluorescein, seen under cobalt blue light. The red arrow is pointing to the apex of the 3.7×1.4 mm corneal laceration.
Seidel test helps rule out a full-thickness corneal defect, which would result in aqueous leak from the anterior chamber. Concentrated 2% fluorescein is applied topically to the eye and illuminated with the cobalt blue light filter on a direct ophthalmoscope or slit lamp. Fluorescein is a flurophore excited by blue light (465–490 nm) and fluorescing yellow–green light (520–530 nm). Concentrated fluorescein is dark orange. Aqueous leak dilutes the fluorescein resulting in a bright yellow fluorescence at the aqueous-fluorescein border.1 This is called a positive test result, which may arise from trauma or corneal melt due to conditions such as rheumatoid arthritis.2
Small-shelved corneal lacerations with a formed anterior chamber may not require suturing as they often heal spontaneously.3 This case was managed conservatively with a bandage contact lens and intensive topical antibiotic (preservative-free 0.5% levofloxacin hourly) and cylcoplegic (cyclopentolate 1% three times a day) eye drops. A Cartella eye shield was used to protect the eye in between clinic reviews. The follow-up period was over 5 weeks with five clinic visits. Final best corrected visual acuity was 6/5. Close follow-up was required as there is a risk of fungal infection from gardening injuries.
Patient’s perspective
I felt very fortunate to avoid surgery and maintain good vision despite a serious eye injury. And it became important for me to spread the word to family and friends about the importance of eye protection.
Learning points
We hope this case is a reminder to the reader of the high clinical value of the simple yet effective Seidel test, which can detect potentially sight-threatening ocular trauma.
Eye and vision-related presentations are very common both in primary and secondary care.4 Lockdown is resulting in more people undertaking home-improvement and gardening work with high-powered tools, which have the propensity to cause penetrating eye injuries.5
The equipment required, a direct ophthalmoscope and fluorescein drops, is routinely held in both the general practice as well as emergency department settings.
Ethics statements
Patient consent for publication
Footnotes
Contributors VA: collected the information and wrote the case report. TG and RMKS: contributed to revising and finalising the manuscript. All authors were involved in the patient’s care.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.