Orbital Subperiosteal Hematoma From Scuba Diving

Abstract

Only a few cases of nontraumatic orbital subperiosteal hematoma due to scuba diving have been reported, and this is the first of such cases that underwent surgical intervention. This injury results from negative pressure within the face mask, suctioning orbital tissues into the mask after incomplete equilibration of pressure on descent. Valsalva maneuver is a second mechanism implicated in the etiology of this injury. Recognition of this injury is of the utmost importance because vision loss is a possible complication if there is compression of the optic nerve or increased intraocular pressure. In many cases of nontraumatic orbital hematoma, conservative management is adequate; however, this case was an exception due to worsening exam findings. Divers may be able to prevent this injury by frequent and gentle equilibration of mask pressure on descent.

Preventable Diving-related Ocular Barotrauma: A Case Report

“…Tissue damage is mostly minor, such as subconjunctival hemorrhage, but in severe cases it might be more significant, such as subperiosteal hemorrhage which requires surgical intervention. 2,3,4 Subconjunctival hemorrhage caused by diving does not require treatment and heals spontaneously, although recurrent hemorrhages resulting from recreational diving might be distressing for the patient.…”

Non-traumatic Subperiosteal Orbital Hemorrhage Secondary to Barotrauma

“…The former is less common and have been reported in cases related to sudden elevation of central venous pressures with venous congestion, bleeding diathesis or paranasal sinusitis 1,4,6 . In this case report, our patient was subjected to two contributing mechanisms for hemorrhage during the dive: the negative pressure exerted by the mask on the eye and orbit, along with the strain induced by the Valsalva maneuver.…”

“…This was likely to have caused capillary rupture, which explained the bilateral petechial hemorrhage and chemosis seen in our patient. 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.…”

“…5,9,10 Our patient presented with proptosis, diplopia and weakness in up gaze, all of which were symptoms consistent with subperiosteal hematoma secondary to scuba diving. 4 Atalla et al found that the superior orbital roof, which has the most surface area, was the most common site for NTSOH. 6 The presenting symptoms in this case were in keeping with CT findings as the bleed was adjacent to the orbital roof displacing the superior rectus.…”

“…Five cases have been described in the literature. [1][2][3][4][5] We report one further case of subperiosteal hemorrhage during scuba diving, which responded to conservative management. This article explores the pathophysiology and physics involved in generating such injury, and highlights the importance of adequate pressure equalization while diving.…”