## Pathognomonic Signs of Globe Rupture **Key Point:** The Seidel test (fluorescein dye leakage from the wound site when viewed under cobalt blue light) is the most specific clinical sign indicating full-thickness corneal or scleral laceration with aqueous humor leakage. ### Seidel Test Mechanism When aqueous humor leaks from a full-thickness wound, it dilutes the fluorescein dye locally, creating a dark stream or pooling effect against the bright green background. This is virtually pathognomonic for globe rupture or significant corneal laceration. ### Why Other Signs Are Non-Specific | Sign | Specificity | Clinical Significance | | --- | --- | --- | | Subconjunctival hemorrhage | Low | Can occur with minor trauma, retrobulbar hemorrhage, or orbital fractures | | Hyphema | Low | Indicates anterior chamber bleeding but does not confirm full-thickness injury | | Corneal abrasion | Low | Epithelial loss only; does not indicate globe rupture | | Positive Seidel test | **High** | **Confirms full-thickness breach with aqueous leak** | **Clinical Pearl:** A negative Seidel test does NOT exclude globe rupture if clinical suspicion is high — small wounds may seal temporarily. Always perform careful examination including gonioscopy and B-scan ultrasound if globe integrity is uncertain. **High-Yield:** In any patient with suspected globe rupture, avoid applying pressure to the eye. Perform Seidel test gently; if positive, prepare for emergency surgical repair within 24 hours for optimal visual outcomes [cite:Yanoff & Duker 6e Ch 6]. 
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