SEIDELS TEST

D R . FA H R E Z A
 DEFINITION

The Seidel test is named after the German

ophthalmologist Erich Seidel
The test used to reveal ocular leaks from
the cornea, sclera or conjunctiva following
injury or surgery and sometimes disease is
called Seidel test.
 PRINCIPLE

Aqueous in the anterior chamber is a clear fluid. Tear film

covering the conjunctiva and cornea is also a transparent
layer. Following ocular injury or surgery or any disease, if
ocular leak is present then this fluid will leak out of the eye.
However due to tear film, this aqueous leak disappears and
site of the leak cannot be identified. Thus, if the dye were
injected into aqueous then the site of leak can be identified by
the dye leaking out of the wound. However this is an invasive
procedure, so non-invasive alternative would obviously be
preferable and an alternative approach is the seidel test dye
the tear film. Any aqueous leak will dilute the dyed tears in the
site of leak and the leak would be much more obvious by
color change.
 DYE USED IN SEIDEL TEST

Fluorescein 10 % (Resorcinolphthalein) dye is used in

the seidel test. Fluorescein is a synthetic organic
compound available as a dark orange or red in color. It
can be prepared from phthalic anhydride and resorcinol
in the presence of zinc chloride via the Friedel-Crafts
reaction. As concentrated fluorescein does not actually
fluoresce, it is used in relatively dilute concentrations in
most circumstances. Concentrated fluorescein will be
diluted by the leak which will flow downward due to
gravity and on slit lamp examination by using cobalt blue
light this leak will appear bright green.
 TECHNIQUE

Prepare the slit lamp

Explain the procedure to the patient
Gently apply the topical anesthetic eye drop
Carefully apply moistened Fluorescein dye strip to the superior
conjunctiva.
(In corneal tear, the dye can usually be applied to the superior
conjunctiva, allowing the dye to flow down over the cornea. Another
advantage of applying fluorescein to the superior conjunctiva above the
suspected lesion is that Bells phenomenon whereby the eyes rotate
upward and outward.)
Ask patient to blink once
Visualize the injured site under cobalt blue light source
Estimate the rate and volume of fluid exiting the wound
Apply topical antibiotic eye drop
 INDICATIONS

(1) To identify the site of ocular leak after globe injury

(2) To identify whether the corneal tear is sealed or not
(3) To evaluate different sutureless cataract incision
configurations
(4) Post-operatively to ensure appropriate wound closure
after filtering bleb
 CONTRAINDICATIONS

(1) Obvious Globe rupture

(2) Corneal perforation
(3) Full thickness eye laceration
(4) Hypersensitivity to Fluorescein
 INTERPRETATION (POSITIVE
SEIDEL TEST)
A. Fluorescein dye diluted by aqueous fluid
B. Bright green concentrated dye surrounds leak site
(above and to side
 PRECAUTIONS

Do not apply pressure to eye during test (risk of eye

tissue extrusion)
 REQUIREMENTS

A. Slit lamp with cobalt blue light source

B. Fluorescein strip
C. Topical Anesthetic eye-drops
 MANAGEMENT

A full thickness penetration (leaking wound) should be

treated as an emergency and require prompt surgical
repair. Care must be taken to protect the eye.
A sealed corneal tear (small wound) is treated by applying
bandage contact lens or pressure patching.
Any inadequate wound closure or incision closure needs
to be reviewed. Cyanoacrylate glue and a bandage contact
lens may be applied to close the wound.
Broad-spectrum antibiotics are indicated to decrease any
chance of microbial keratitis or endophthalmitis.
Tetanus prophylaxis is given.
 PROGNOSIS

Depends on the injuries sustained and the extent of

damage at presentation