key: cord-0711290-9prrnhrs
authors: Anakwenze, Vivian; Gout, Taras; Stewart, Rosalind M K
title: More than a scratch: emergency setting eye evaluation during COVID-19 lockdown
date: 2021-01-18
journal: BMJ Case Rep
DOI: 10.1136/bcr-2020-239940
sha: 94cd6ff57a938df61b274d5c82c584db1f23bafe
doc_id: 711290
cord_uid: 9prrnhrs

nan

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 ).

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.

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.

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Provenance and peer review Not commissioned; externally peer reviewed.

Taras Gout http:// orcid. org/ 0000-0001-9428-2245 

► 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 sightthreatening 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.

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