The Eye That Hid Its Wound: A Case Report of Corneal Perforation Despite a Negative Seidel Test

A 58-year-old man presented with pain, redness, watering, and sudden diminution of vision in the right eye following blunt trauma from a stone. Slit-lamp examination revealed mild corneal edema, a central corneal defect, a traumatic cataract with probable anterior lens subluxation, and a distinct air bubble within the anterior chamber. Seidel's test was negative, and no iris prolapse or obvious corneal laceration was identified. The presence of intracameral air raised a strong suspicion of prior communication between the anterior chamber and the external environment, suggestive of a self-sealed corneal perforation, probably secondary to countercoup forces generated by blunt trauma. B-scan ultrasonography demonstrated an attached retina in all quadrants. Prompt surgical management was undertaken, resulting in restoration of globe integrity and stabilization of the ocular condition. Occult open-globe injuries following blunt trauma may present without an overt wound leak or classic signs of perforation. An isolated intracameral air bubble should alert clinicians to the possibility of a self-sealed globe injury, even in the setting of a negative Seidel test. Careful anterior segment evaluation and timely intervention are essential to prevent vision-threatening complications and preserve ocular integrity.