Temporary Blindness

[DocVikingo]

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

You are so right--one certainly never does know. We've had more than one thread in the Diving Medicine forum that ended up in a rather different place than where it started, e.g., http://www.scubaboard.com/forums/diving-medicine/316265-diving-chemo.html

Regards,

Doc

 

[Duke Dive Medicine]

Indeed. I wasn't on SB in 2009 but saw your last post in that thread. Very difficult situation, handled well.

 

[Jax]

Welcome, aviayu, to ScubaBoard!!! I hope you will continue to visit us in our other forums, as well.

Please let us know the outcome of this.

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,…).

 

[Kelvin@sea]

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

Thanks Duke,

He saw an ophthalmologist. His eye pressure and retina is normal. He also answered me there was no other symptom of ox-tox. And I don’t think the dive shop will so foolish to fill an ordinary tank with pure oxygen by mistake. Even a 50% oxygen, PPO2 1.6 will not be toxic at the first moment. I think impingement of the retinal artery related to chronic sinusitis should be the answer.

Kelvin

 

[aviayu]

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

I am a man and nearly 50 years old, no health problem, and also did not find any problem with my eyes, sinus or ear related.

I did not forcefully clear my ears and/or sinuses on descent, because that did not work for me to do ear equalization (pinch nose to do equalization does not really work for me), normally I swallow for ear equalization.

As I remember, It looked like curtain falling in front of my eyes suddenly one by one, not in one spot and then spread.

Good to know that Chronic sinusitis may cause temporary blindness, I will check with doctor if I have the problem. Your link is only a abstract of the article, could you send me the whole article, my email: aviayu@hotmail.com

I have just did some checks on my eyes in the Hospital, likes tonometry / color photo of fundus / visual field, the doctor said the results showed no problem except I lost some points on visual field.

The doctor did not mention if I have incipient/subclinical glaucoma. is the glaucoma serious for diving?

 

[DocVikingo]

The doctor did not mention if I have incipient/subclinical glaucoma. is the glaucoma serious for diving?

Hi aviayu,

Of course your treating ophthalmologist has the final word on this, but it appears that in general SCUBA should not pose addditional risks given a diagnosis incipient/subclinical glaucoma (not otherwise specified).

Here are two sites to get you both started:


1. DAN Divers Alert Network : High-Pressure Ophthalmology

I quote in particular: “Is it dangerous to dive if you have glaucoma?

Glaucoma is a disease in which increased pressure inside the eye is associated with damage to the optic nerve and loss of vision. Because of this, physicians have voiced concern about the possibility that a hyperbaric environment might therefore cause increased damage to the eye. Although this would seem to be a logical conclusion, diving thus far has not been shown to be a problem for glaucoma patients. This is most likely because the damage associated with glaucoma is a factor of the difference between the pressure inside the eye and the surrounding pressure, rather than simply the absolute magnitude of the pressure inside the eye.

There are two important considerations for glaucoma patients who wish to dive. Some of the medications used to lower the pressure in the eyes of glaucoma patients may have adverse effects while diving. Timolol, for example, may result in a decrease in heart rate that could theoretically place a small percentage of divers at higher risk for loss of consciousness underwater; acetazolamide (Diamox) may cause tingling sensations of the hands and feet that could be mistaken for symptoms of decompression sickness. These and other ocular medications are discussed in detail in the article mentioned in the introduction.

Certain types of glaucoma surgery (collectively called glaucoma filtering procedures) create a communication between the anterior chamber of the eye and the subconjunctival space to help lower the pressure in the eye. Facemask barotrauma may have an adverse effect on the functioning of the filter and result in a need for additional surgery or further damage to the eye from the glaucoma.

Individuals who have had glaucoma surgery or who are taking glaucoma medications should check with their ophthalmologist before diving.”


2. Eye Problems – Glaucoma
e-med Private Medical Services - Scuba Diving Medical Advice - Eye Problems | Glaucoma

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]

Thanks Duke,

He saw an ophthalmologist. His eye pressure and retina is normal. He also answered me there was no other symptom of ox-tox. And I don’t think the dive shop will so foolish to fill an ordinary tank with pure oxygen by mistake. Even a 50% oxygen, PPO2 1.6 will not be toxic at the first moment. I think impingement of the retinal artery related to chronic sinusitis should be the answer.
Kelvin

Thanks Kelvin. If his intraocular pressure was normal, it's very unlikely that his symptoms were due to glaucoma. His symptom onset (see below) isn't typical of central retinal artery occlusion (CRAO), either; CRAO classically presents as sudden, painless vision loss or visual defect.

I am a man and nearly 50 years old, no health problem, and also did not find any problem with my eyes, sinus or ear related.

I did not forcefully clear my ears and/or sinuses on descent, because that did not work for me to do ear equalization (pinch nose to do equalization does not really work for me), normally I swallow for ear equalization.

As I remember, It looked like curtain falling in front of my eyes suddenly one by one, not in one spot and then spread.

Good to know that Chronic sinusitis may cause temporary blindness, I will check with doctor if I have the problem. Your link is only a abstract of the article, could you send me the whole article, my email: aviayu@hotmail.com

I have just did some checks on my eyes in the Hospital, likes tonometry / color photo of fundus / visual field, the doctor said the results showed no problem except I lost some points on visual field.

The doctor did not mention if I have incipient/subclinical glaucoma. is the glaucoma serious for diving?

Aviayu,
As I said to Kelvin above, if your intraocular pressure is normal, it's very unlikely that you have glaucoma. Your description of your symptom onset ("it looked like a curtain falling in front of my eyes") is classic for retinal detachment; however, Kelvin said above that your retinal examination was normal, so I need to ask you a few more questions:

1. When you saw the ophthalmologist, did you tell him exactly what you wrote here about your symptom onset (looked like a curtain falling)?
2. Did you take any photos of your eyes after the dive? If so, can you forward them to me?

I'll try to forward the entire article to you via email. There's a way to access the full text of the article from PubMed but Duke has a subscription to many of the PubMed services so it may be because I'm on a hospital computer that I can get to it.

Best regards,
DDM

 

[DocVikingo]

If his intraocular pressure was normal, it's very unlikely that his symptoms were due to glaucoma.

There always the possibility of normal pressure/normal tension glaucoma, but I agree that the reports of symptoms and medical work up to date simply are not consistent with glaucoma-related visual disturbance.

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.

 

[aviayu]

Thanks Kelvin. If his intraocular pressure was normal, it's very unlikely that his symptoms were due to glaucoma. His symptom onset (see below) isn't typical of central retinal artery occlusion (CRAO), either; CRAO classically presents as sudden, painless vision loss or visual defect.



Aviayu,
As I said to Kelvin above, if your intraocular pressure is normal, it's very unlikely that you have glaucoma. Your description of your symptom onset ("it looked like a curtain falling in front of my eyes") is classic for retinal detachment; however, Kelvin said above that your retinal examination was normal, so I need to ask you a few more questions:

1. When you saw the ophthalmologist, did you tell him exactly what you wrote here about your symptom onset (looked like a curtain falling)?
2. Did you take any photos of your eyes after the dive? If so, can you forward them to me?

I'll try to forward the entire article to you via email. There's a way to access the full text of the article from PubMed but Duke has a subscription to many of the PubMed services so it may be because I'm on a hospital computer that I can get to it.

Best regards,
DDM

I have just done the eyes examination yesterday, I told whole story on my eyes to the ophthalmologist. I did the examination of tonometry / color photo of fundus / visual field on my eyes, the doctor said the results showed no problem. But I do not know which result represents my retinal examination was normal. (I did not say to Kelvin my retinal examination was normal), I think color photo of fundus for retinal examination, is that right?

Sorry, I did not take any photos on eyes at that time.

 

[aviayu]

Hi aviayu,

Of course your treating ophthalmologist has the final word on this, but it appears that in general SCUBA should not pose addditional risks given a diagnosis incipient/subclinical glaucoma (not otherwise specified).

Here are two sites to get you both started:


1. DAN Divers Alert Network : High-Pressure Ophthalmology

I quote in particular: “Is it dangerous to dive if you have glaucoma?

Glaucoma is a disease in which increased pressure inside the eye is associated with damage to the optic nerve and loss of vision. Because of this, physicians have voiced concern about the possibility that a hyperbaric environment might therefore cause increased damage to the eye. Although this would seem to be a logical conclusion, diving thus far has not been shown to be a problem for glaucoma patients. This is most likely because the damage associated with glaucoma is a factor of the difference between the pressure inside the eye and the surrounding pressure, rather than simply the absolute magnitude of the pressure inside the eye.

There are two important considerations for glaucoma patients who wish to dive. Some of the medications used to lower the pressure in the eyes of glaucoma patients may have adverse effects while diving. Timolol, for example, may result in a decrease in heart rate that could theoretically place a small percentage of divers at higher risk for loss of consciousness underwater; acetazolamide (Diamox) may cause tingling sensations of the hands and feet that could be mistaken for symptoms of decompression sickness. These and other ocular medications are discussed in detail in the article mentioned in the introduction.

Certain types of glaucoma surgery (collectively called glaucoma filtering procedures) create a communication between the anterior chamber of the eye and the subconjunctival space to help lower the pressure in the eye. Facemask barotrauma may have an adverse effect on the functioning of the filter and result in a need for additional surgery or further damage to the eye from the glaucoma.

Individuals who have had glaucoma surgery or who are taking glaucoma medications should check with their ophthalmologist before diving.”


2. Eye Problems – Glaucoma
e-med Private Medical Services - Scuba Diving Medical Advice - Eye Problems | Glaucoma

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.

Happy to know “diving thus far has not been shown to be a problem for glaucoma patients”. Do you know any cases which was similar with my case(temporary blind).

Even I have glaucoma, it seems to be a incipient/subclinical glaucoma or normal pressure/normal tension glaucoma, is it really a problem that affect my diving?