Pseudo Seidels Positivity Post Photo-Therapeutic Keratectomy :A Case Report

We report a unique case of pseudo seidels positivity in a patient of pseudo phakic bullous keratopathy with secondary glaucoma with no evidence of corneal perforation, fistula or thinning following phototherapeutic keratectomy (PTK). On subsequent control of intra ocular pressure (IOP), the patient became seidels negative.

Seidels test is a significant and commonly performed test to detect aqueous humour leak. A Seidels test is said to be positive whenever there is aqueous humour leakage from a defect in the cornea or sclera from multiple causes, including trauma, post-surgical leak, and corneal perforation. A positive seidels test is an alarming sign which warrants management of the corneal or scleral defect to prevent keratitis or endophthalmitis.

A 19 year old male patient presented to our clinic with complaints of pain, watering and photophobia in his right eye for the past three years with past history of traumatic cataract and ACIOL implantation 10 year back. He had diffuse corneal edema with diffuse stromal haze with epithelial bullae, ACIOL was stable and anterior chamber was deep. B scan of RE revealed anechoic vitreous with optic nerve head cupping.CCT was 702 microns on ASOCT. Patient underwent PTK for symptomatic relief using excimer laser with an ablation depth of 100 microns and a treatment zone of 7.5 mm. 1 week after PTK , BCL was removed and checked for any epithelial defects. Incidentally we came across multiple areas of seidels positivity without any evidence of perforation, fistula or any areas of thinning. The IOP in RE was 40 mm of Hg on tonopen. The patient was started on oral and topical anti glaucoma medications for 1 week. On follow up, the IOP was 16 mm of Hg when measured with tonopen and we could not find any areas of seidels positivity. In our patient we suspected fluorescein dye pooling due to irregular epithelial surface. But the fluorescein stain was getting diluted without eye blink which was classical of a seidels positivity. Since the fluid that came out of the oedematous cornea was a transudated fluid that was present in the corneal stroma and not a direct aqueous leak, we labelled this as false seidels positivity. 

1. Corneal edema with high IOP can give a false positive seidels test

2. Control of IOP is imperative for epithelial integrity

3. False positive seidels test can be used as an indirect evidence of high IOP in edematous cornea.