DCS in optic nerve. PFO?

[scottishscuba]

Its taken me a long time to pluck up the courage to post this (and please no mention of Multiple Sclerosis, I know its a risk factor, I've discussed it with my specialists and he is adamant that its DCS)

Halfway through my recent trip to Dahab, Egypt and following completion of my PADI rescue diver course, I noticed a strange change in my vision. My right eye had lost its central vision, much like I get when I experience migraines. I doped up on painkillers and continued on our planned excursion to Petra in Jordan (amazing BW). on returning from Jordan I realised that my vision was a lot worse so arranged to see a Dr in Dahab. He ballsed up and didn't actually follow his medical training. He said I had a corneal ulcer (despite no epiphora, pain or any redness at all - I'm a vet so used to the signs in dogs and cats) gave me STEROID drops (OMG) and told me to see him again the following day. I went back and the sight was just as bad, total loss of central vision still no pain or redness. he said to continue drops and see him again the following day.. As we were travelling home anyway I wasn't too worried (though DCS had passed briefly through my head, he is a hyperbaric specialist and I trusted that it wasnt THAT) so flew home and attended my local hospital which is a centre of excellence in ophthalmology.

Saw a lovely Dr in A & E and was referred to ophth. as a matter of urgency . Anyway the long and short of it was an Optic Neuritis diagnosis which the docs are adamant is related to the diving (there were long long conversations with the dive specialists in Aberdeen while they decided how best to proceed) I've had 6 sessions of HBOT and my vision is slowly improving. Peripherally I've got some shadowy vision back but in the centre there is still nothing. Apparently the symptoms are clearing up much better than if it were a demyelinating disorder and the speed (and extent) of recovery is now due to the fact that the HBOT was severely delayed and that I flew home.

I had a call from the specialist again today (9 days after my DCS diagnosis) and he has been advised to refer me to a cardiologist to check for a patent foramen ovale.

Now my reading around the subject today suggests that 20% of the population have PFO and that it poses a significant risk of cerebral DCS. I've tried searching on here but I'm obviously not putting in the right terminology.

Has anyone got any snippets of info they may care to share on DCS hits on the optic nerve or PFO in diving. I understand that if it is a PFO, I'll not be diving again (according to the Doc I spoke to today anyway). I'm reeling a bit that such shallow dives could cause such catastrophic DCS, and I wonder if its the nature of the rescue course where you do several ascents from depth bringing up simulated bodies or air sharing ascents etc that has caused this. I know I'll never know exactly what happened but I am trying to make sense of it all. Thanks goodness it was "only" my right eye.

 

[DandyDon]

Now my reading around the subject today suggests that 20% of the population have PFO and that it poses a significant risk of cerebral DCS.

Some suggest that a greater part of the population have PFOs, but the vast majority of divers who have them never have DCS problems. It's a condition well deserving of study, but the answers are not in yet. DAN does not suggest a PFO test even after a more significant hit. Many lay divers will, but the experts are not in agreement.

Good luck on your treatment. It's a little late for chamber treatments, but the general rule seems to be: As long as they help, continue...

 

[boulderjohn]

This is a pretty good summary.

Patent Foramen Ovale and How It Affects Diving

 

[mathauck0814]

Scary stuff - anything in your dive profiles that would have made you prone to taking a hit? Were you pushing up against NDLs or remember having ascents that maybe didn't go quite as well as you'd have liked? (it happens and it's easy to do on a multiday trip like that).

 

[dmoore19]

Could this be a case of AGE rather than DCS?

 

[scottishscuba]

Possibly AGE, Shall I call it DCI then?

There was nothing on my profiles that were red flags really, none of the rescue diver course dives were to deeper than 10 m and although you don't hold a 3m safety stop when bringing up a "body" our ascents were not overly fast, my computer is quite conservative (Mares puck pro) and it didn't start beeping at me. I really am not gung-ho when it comes to diving safety which is why I wanted to do the rescue course! The other dives that I did before the start of the course were nice easy long slow ascent dives where I felt nice and relaxed.

BoulderJohn, thanks for the link I'll go and have a gander now.

 

[Duke Dive Medicine]

With the caveat that you didn't provide any information about your symptom onset time, I think it's highly unlikely that your isolated change in vision is related to decompression illness, especially if your dives were to 10 meters or less.

PFO is associated with severe neurological DCS (paralysis, significant mental status changes), inner ear DCS and/or cutis marmorata that occur in the setting of a dive that is likely to produce clinically significant bubbles. Given the information you have provided here, I don't believe there is any indication for PFO testing in your case; even if you have one, it's probably a red herring.

Did your specialist say why he is so convinced that this is DCS and not an MS exacerbation? Optic neuritis can occur independent of diving, as can central retinal artery occlusion, ocular migraine and a host other optic issues not necessarily related to multiple sclerosis. If you have MS you probably know as much or more about it than I do, but here's a link that you or other readers may find helpful:

Medscape: Medscape Access

Did you have any other symptoms at all? Exactly when did you notice this change in vision? Did it happen during or after diving? If it happened while diving, exactly where were you in the water column and what were you doing at the time? If it happened after diving, how long after your last dive did it occur? Did it happen all at once, or was the onset gradual? Did you notice anything unusual about any of the dives?

Best regards,
DDM

 

[Dr Deco]

Thia does not sound like a DCS event, to me.

 

[scottishscuba]

I noticed the central visual loss in the evening after diving so a few hours after I'd been diving. I suffer from migraines that cause a central aura so I'm quite "good" at seeing past them and don't notice them until they are really bad. The symptoms continued to worsen in the following days and I sought medical advice when I was out there. The symptoms definitely worsened when I flew home.

Several hyperbaric specialists have been consulted and they are sure that this is some sort of diving insult. There are apparently reports in the literature of optic neuritis following diving to as little as 5m! (Though I've been unable to find these reports on pubmed)

I do not have MS and the specialists I've spoken to are quite adamant of that (My vision is returning too quickly for it to be a demyelinating disorder) I have not had (and do not intend to have) a scan. I'm being guided by the specialists that are trying to help me, and PFO seems like a likely cause of AGE and a cause of optic neuritis. From where I'm sitting this is pretty darned serious injury!

 

[diver 85]

Please provide retinal photos along with the results of the MOCT..............I'm thinking more of a BRVO(vascular occlusion) or CSR problem????......