Cornea
Wound Leak
Also known as: wound leak, seidel positive, post operative leak, post-op wound leak, hypotony after surgery
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Aqueous escaping through a surgical or traumatic wound, presenting as a postoperative eye that is not settling, with irritation and unstable vision. A positive Seidel test is the finding, sometimes alongside a shallow anterior chamber or a low pressure. An unsealed wound is a route for infection, so it warrants prompt ophthalmology review rather than continued observation.
Recognition
Symptoms: what patients report
- Post-operative discomfort or irritation that is not settling as expected.
- Blurred or unstable vision during early recovery.
- Symptoms may feel more unstable than routine postoperative redness alone.
Signs: what the examination shows
- Positive Seidel test — a spontaneous leak; do not press on the globe to elicit one when wound integrity is uncertain.
- Low IOP where it has already been measured; persistent hypotony after surgery can come from a subtle leak.
- Anterior chamber shallower than the fellow eye.
- Poorly apposed or separated wound.
What OptoGuide™ covers for wound leak
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked New Zealand therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Occult Wound Leak Diagnosed by Ultrasound Biomicroscopy in Patients With Postoperative Hypotony. Sicco thoe Schwartzenberg GW, Pavlin CJ. Journal of Cataract and Refractive Surgery. 2001;27(4):549-54.
- Interventions for Late Trabeculectomy Bleb Leak. Bochmann F, Azuara-Blanco A. The Cochrane Database of Systematic Reviews. 2012;(9):CD006769.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.