This finding is seen in a construction worker who had acute vision loss at work. On exam, you note that this pupil constricts when light is shined on the opposite eye, but there is less constriction when light is shined on the affected eye. When fluorescin is placed, you note this (they are different pictures, but imagine the top of the green to be the top of the teardrop pupil):Challenge: Where's the injury? What happened?
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Corneal laceration or globe rupture. Blunt force injury to the cornea causing the iris to prolapse out.
Seidel sign, caused by a matter that did enter the eye (probably at the limbus) which caused a iris prolapse...?
yes indeed! i am duly impressed. the eye always scared me. i hadn't heard of seidel sign until i had my emergency rotation, and at that time, i couldn't even spell it.
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Teardrop
This is an open globe injury (rupture or laceration). There is visual loss, an afferent pupillary defect, and a peaked pupil (corectopia) which points towards the defect. When fluorescin is placed, the streaming away from the site (like a waterfall) is called Seidel sign.
Sources: UpToDate; webeye.ophth.uiowa.edu.
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