Novel sign to check wound leak intraoperatively: ‘Bloody Seidel’s’

Description

We would like to describe a common observation as a new sign ‘Bloody Seidel’s’. Seidel’s test, named after the German ophthalmologist Erich Seidel, is used to reveal leaks of intraocular fluid from the cornea, sclera or conjunctiva following injury or surgery. The principle of the Seidel’s test is to apply a dye to the ocular surface so that any aqueous leak encompassed by the dye will dilute it, allowing the leak to become more obvious by the colour change. The dye commonly used is 10% sodium resorcinolphthalein (fluorescein).¹ A dye is used because otherwise transparent aqueous is difficult to spot leaking into transparent tear film. We thought of using another pigmented fluid for the same—that is blood. In case a limbal vessel is cut/damaged during anterior segment incision making, the blood leak from it guides us if the respective wound is secure. In case of leak, the fluid from the anterior chamber keeps washing the blood oozing from the limbal vessel (figure 1A). If the wound is fluid secure, there is no fluid to wash off the oozing blood, as a result the blood starts accumulating along the contour of the wound (figure 1B). A good hydrated wound acts like a valve, preventing fluid movement either ways. So, we would like to propose this as a sign of whether a wound is fluid secure or not.

Figure 1.

(A) Blood actively trickling away from the wound indicating it is being actively washed by the fluid leaking from the wound; (B) Blood accumulating along the contour of the wound indicating that the leak has stopped.

Learning points.

• Seidel’s test is used to check leaks from the anterior chamber postsurgery or trauma.

• Any pigmented fluid like blood can act as similar marker and an alternative to externally applied dye.