Diplopia Due to Mask Barotrauma

Orbital Subperiosteal Hematoma From Scuba Diving

“…11 A review of the literature yielded only four prior case reports of scuba diving-induced orbital subperiosteal hematomas. [1][2][3][4] The pathogenesis of these injuries due to diving is relatively straightforward. As a diver descends with face mask in place, the surrounding water pressure increases creating a relative negative pressure within the mask.…”

“…The four previous cases required no intervention and resolved over time without any major long-term sequaela. [1][2][3][4] One patient did report at 3 months' follow-up that her affected eye remained more prominent than the other. 4 Our case is novel in that it is the first reported nontraumatic orbital subperiosteal hematoma where an orbitotomy was felt necessary.…”

“…Diagnosis of subperiosteal hematoma with CT or magnetic resonance imaging (MRI) has been successful. [1][2][3][4][5][6][7][8][9][10][11] Treatment recommendations for nontraumatic subperiosteal hematomas center around conservative management, but needle aspiration or orbitotomy with drainage may be necessary. Surgical indications include elevated intraocular pressures, vision loss, or worsening signs and symptoms that suggest an expanding hematoma and impending vision loss.…”

“…Four prior cases associated with scuba diving have been reported. [1][2][3][4] This is only the fifth case of a scuba diving-induced orbital subperiosteal hematoma described, and it is the first case to undergo orbitotomy to correct worsening signs. Recognizing this entity has significant clinical value because compression of the optic nerve and intraocular pressure elevation are possible and can result in vision loss.…”

Non-traumatic Subperiosteal Orbital Hemorrhage Secondary to Barotrauma

“…1,3,4 Furthermore, this force increased the risk of hemorrhage from vascular injury when pressure overcomes the adhesive forces between the periosteum and the underlying bone. 3,5,8 The Valsalva maneuver further contributed to the hemorrhage. Our patient performed this during descent to equalize middle ear pressure through forced expiration against a tightly shut mouth and nostrils.…”