Temporary Blindness

[Kelvin@sea]

A diver in a Chinese forum mentioned that he was suffered from a temporary blindness. It is difficult to seek medical advice in Beijing and I think asking for help here should be the quickest and appropriate way.

He wrote：I dove in New Zealand Paihia. The water was cold. I wore 7MM full suit and hood. When I descend to 22M , one of the eye vision was faded out. When I descended to 26M , both my eyes were blinded. The dive guide took me upwards and when I ascended to 7 -8M , my version gradually resumed and returned to normal after reaching the surface. I found my eyes swelled and red and there was a little blood on the mask. The dive guide said it is a mask squeeze.

He will see a doctor but there is no doctor specialised in diving medicine locally. I believe seeking a comment here before visiting the doctor will be better.

I met serious mask squeeze before. The patient’s eyes look like a panda. But I never hear a mask squeeze will cause a temporary blindness. Please help.

 

[cutlass]

These are some questions that might be asked of him:

Which eye was affected first? Just to confirm, was it distinctly one eye (at 22m) and then the other (at 26m), or did one start first and then the other overlapped so that eventually both went out together (at 26m)? Which one (or both) recovered first? Was there a pattern to the vision loss? For example, was it like a curtain falling, or like a curtain closing left-to-right or right-to-left or did expand from a spot or contract to a spot or was it a fairly even, overall fade-out?

As for the blood, was it very red as from a cut or did seem diluted with serum (which obviously might've been hard to tell if his mask had a little water)? Were there any other abnormal fluids draining from the ears or mouth?

Were there any other problems such as with hearing, smelling, taste, or facial sensations? Did he such problems before? Did he ever have a head injury (fall, fight, accident), even as a child? Sinus problems? "Panda" or "raccoon" eyes is sometimes associated with a prior (up to a few days) injury to the skull. This might not be the case here but could suggest a starting point for examination.

Because vision may be involved, I certainly wouldn't wave this off as simply mask squeeze.

 

[ScubaMarc]

Questions: at 22 meters you go blind in 1 eye and then the diver keeps descending 4 more meters why not abort the dive?
Also, the diver knows the exact depth this happened? (I can understand if the diver wants to know where he is before making some call)


I am not making light of this, just wondering about the facts.

 

[aviayu]

These are some questions that might be asked of him:

Which eye was affected first? Just to confirm, was it distinctly one eye (at 22m) and then the other (at 26m), or did one start first and then the other overlapped so that eventually both went out together (at 26m)? Which one (or both) recovered first? Was there a pattern to the vision loss? For example, was it like a curtain falling, or like a curtain closing left-to-right or right-to-left or did expand from a spot or contract to a spot or was it a fairly even, overall fade-out?

As for the blood, was it very red as from a cut or did seem diluted with serum (which obviously might've been hard to tell if his mask had a little water)? Were there any other abnormal fluids draining from the ears or mouth?

Were there any other problems such as with hearing, smelling, taste, or facial sensations? Did he such problems before? Did he ever have a head injury (fall, fight, accident), even as a child? Sinus problems? "Panda" or "raccoon" eyes is sometimes associated with a prior (up to a few days) injury to the skull. This might not be the case here but could suggest a starting point for examination.

Because vision may be involved, I certainly wouldn't wave this off as simply mask squeeze.

I am the Chinese diver met with the temporary blindness. For your question:
- Right eye with the problem first, I thought it might be caught by right side mask fogged up, so I kept going down. 22m is about and not exactly. 26m was correct because my diving computer have the number.
- Right eye was blind at about 22m, at that time the left eye still can see the things but felt not good .I feel not overlapped, just one can see the thing and the other not.
- Even, overall fade-out (blackout), can not see even weak light.
- No blood and any other fluids were coming out. Both my eyes’ rim was swollen and eyes were hyperemia. The contact part with mask on the face had blood patch.
- No any problem on me you mentioned (hearing, …, accident, …, skull,…).

 

[Duke Dive Medicine]

I am the Chinese diver met with the temporary blindness. For your question:
- Right eye with the problem first, I thought it might be caught by right side mask fogged up, so I kept going down. 22m is about and not exactly. 26m was correct because my diving computer have the number.
- Right eye was blind at about 22m, at that time the left eye still can see the things but felt not good .I feel not overlapped, just one can see the thing and the other not.
- Even, overall fade-out (blackout), can not see even weak light.
- No blood and any other fluids were coming out. Both my eyes’ rim was swollen and eyes were hyperemia. The contact part with mask on the face had blood patch.
- No any problem on me you mentioned (hearing, …, accident, …, skull,…).

Aviayu,
I believe you had a severe mask squeeze but other, more severe problems cannot be excluded. You may also have had a sinus squeeze. Do you remember if your sinuses were clogged on this dive?
If it was a mask squeeze: to prevent this problem from happening again, make sure to equalize your mask on descent by gently blowing air out of your nose.
Please do not dive again until you are evaluated by a physician. You will need to give your eyes time to heal, and hopefully you can get to see a physician during the time your eyes are healing.
Best regards,
DDM

 

[Kelvin@sea]

I came across a severe mask squeeze. When we came back to the surface, I found a lady with her eyes look like a panda. The color was dark red, not exactly red or black. The dark area sized as an egg. Her eyes were full with blood. What happened to you, I asked. She looked at me and asked what was wrong. She didn’t know anything!!!

In aviayu’s case, it seems to be a nerve problem. Is it possible he was suffered from oxygen toxicity? We can’t rule out a mistake in the gas.

 

[DocVikingo]

Is it possible he was suffered from oxygen toxicity? We can’t rule out a mistake in the gas.

Hi Kelvin,

If transient total blindness of the R-eye coupled with a L-eye that did not feel right but was not impaired visually is the sole complaint, it's very unlikely that ox-tox or a cylinder gas issue was involved.

The description of swollen rims and "hyperemia" bilaterally with blood in the mask certainly is suggestive of mask squeeze, but of course not conclusive.

The previous advice to have this event evaluated by a physician is medically prudent.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[Duke Dive Medicine]

I came across a severe mask squeeze. When we came back to the surface, I found a lady with her eyes look like a panda. The color was dark red, not exactly red or black. The dark area sized as an egg. Her eyes were full with blood. What happened to you, I asked. She looked at me and asked what was wrong. She didn’t know anything!!!

In aviayu’s case, it seems to be a nerve problem. Is it possible he was suffered from oxygen toxicity? We can’t rule out a mistake in the gas.

How old is aviayu? Does he have any other health problems, especially eye, sinus or ear related?

(EDIT): Also, did he forcefully clear his ears and/or sinuses on descent?

Additionally, it would be very helpful if you or he could answer Cutlass' questions about the nature of the vision loss: did the vision get blurry then fade, did it look like a curtain fell in front of him, did the vision loss start in one spot and then spread, etc? (END EDIT)

Visual disturbances like blurred or tunnel vision can be a symptom of oxygen toxicity, but "overall fadeout (blackout), can not even see weak light" would be a pretty unusual. Aviayu also describes swollen, red-rimmed eyes which is not indicative of O2 toxicity. Mask squeezes can vary greatly in their appearance - I've seen very mild cases, and I've also seen guys who look like they've taken a 1-2 punch from Mike Tyson.

Air pressure in the sinuses can have wide-ranging effects. There is at least one case report of temporary blindness from impingement of the retinal artery related to chronic sinusits in a diver:

Laryngoscope. 2000 Aug;110(8):1358-60.
Neurological consequences of scuba diving with chronic sinusitis.
Parell GJ, Becker GD.

link:
Neurological consequences of scuba diving with chr... [Laryngoscope. 2000] - PubMed result

Aviayu will also want to rule other things out. The loss of vision could mean that he has something else happening in his eyes. If he has incipient/subclinical glaucoma, a change in the pressure in his eyes could result in a loss of vision. He also may have some retinal artery abnormalities.

I really think that he needs to be seen by an ENT (ear/nose/throat) physician and also an ophthalmologist.

Best regards,
DDM

 

[DocVikingo]

Visual disturbances like blurred or tunnel vision can be a symptom of oxygen toxicity, but "overall fadeout (blackout), can not even see weak light" would be a pretty unusual.]

True. And otherwise in neurological isolation, e.g., absence of convulsions, alterations in consciousness, tinnitus, muscle twitching, alterations in mood or behavior, it would be even more unusual.

Regards,

DocVikingo

 

[Duke Dive Medicine]

Visual disturbances like blurred or tunnel vision can be a symptom of oxygen toxicity, but "overall fadeout (blackout), can not even see weak light" would be a pretty unusual.]

True. And otherwise in neurological isolation, e.g., absence of convulsions, alterations in consciousness, tinnitus, muscle twitching, alterations in mood or behavior, it would be even more unusual.

Regards,

DocVikingo

Of course. Figured he'd have mentioned something like that but you never know.