What is Diving Mask Squeeze?
Mask squeeze is a type of face injury that commonly happens when diving with a self-contained underwater breathing apparatus (SCUBA) or when freediving. This condition happens when divers don’t balance the pressure inside their face mask with the water pressure as they go deeper. This imbalance creates a negative pressure compared to the water around the diver.
This pressure difference inside and outside the diving mask can harm the blood vessels and the tissue of the eyes as well as the skin covered by the mask, like the forehead, nasal areas, and the regions around the eyes. The biggest risk factor for mask squeeze is being an inexperienced diver.
Masks that have a large internal volume or using snorkeling masks or swim masks that don’t cover the nose can also raise the risk of this kind of injury. People who’ve had recent eye surgery or have a preexisting condition like glaucoma may also have a higher chance of injury.
What Causes Diving Mask Squeeze?
Barotrauma related to diving happens when there is a pressure difference between two areas filled with air. This can result in what’s known as a ‘mask squeeze’. As you dive deeper, the water pressure around you increases. According to a principle known as Boyle’s Law, the volume must change to balance this increase in pressure. This usually happens if the diver exhales some of their air through the nose, which increases the pressure inside the mask to keep it the same volume.
Problems arise when a diver doesn’t exhale enough. If this happens, the pressure in the mask stays the same while the water pressure increases. This results in the air inside the mask trying to contract, which causes a relative negative pressure or a ‘suction’ effect on the face.
When this ‘suction’ is applied to mask-covered areas, it can cause damage by bursting tissue cells and small blood vessels, leading to bruises or ecchymosis. In rare cases, pressure changes can even cause injuries to the eyes, including bleeding in the lining of the eyeball or the formation of a hematoma (a blood build-up) underneath the outer layer of eye bone.
Risk Factors and Frequency for Diving Mask Squeeze
Scuba divers, freedivers, and swimmers using goggles or masks that don’t cover the nose are all susceptible to a condition known as mask squeeze, especially if they are inexperienced. This occurs when they go beneath the water’s surface. In the U.S, it is estimated that at least 500 such underwater pressure-related injuries happen annually. However, many mild cases might not be reported. The Diver Alert Network (DAN) has set up a reporting system and possesses the most extensive database of such reported injuries.
Signs and Symptoms of Diving Mask Squeeze
Knowing the patient’s history is crucial for diagnosing any conditions. If the person has recently been SCUBA diving or freediving, especially if they’re inexperienced or have dived deep, it could be a clue. Mild issues associated with diving often include facial pain, redness, bruising, swelling around the eye, or small blood spots in the eye. In rare cases, more serious eye injuries can happen. Signs of such injuries include eye pain, bulging of the eye, difficulty moving the eye, double vision, and changes in sight. Additionally, other symptoms like shortness of breath, cough, ear pain, nosebleeds, and dizziness might hint at other types of diving-related injuries. The individual or their companions might also suspect a decompression illness.
- Facial pain
- Redness
- Bruising
- Swelling around the eye
- Small blood spots in the eye
- Eye pain
- Bulging of the eye
- Difficulty moving the eye
- Double vision
- Changes in sight
- Shortness of breath
- Cough
- Ear pain
- Nosebleeds
- Dizziness
Physical examination will focus on the areas involved, especially the eyes, area around the eyes, upper part of the face, and forehead. At the very least, the doctor will check visual sharpness, range of eye movement, and whether there is double vision. If there’s a suspicion of serious eye injury, an eye specialist is needed. If decompression illness is suspect, a more extensive evaluation will be needed.
Testing for Diving Mask Squeeze
In most cases, the current medical history, a review of all body systems, and a physical examination are enough to diagnose an illness. However, if the doctor finds any irregularities in the patient’s vision – such as double vision, bulging eyes, or limited eye movement – they may request a CT or MRI scan of the eye area to investigate further.
Treatment Options for Diving Mask Squeeze
Most injuries due to mask squeeze, such as mild skin injuries like swelling, bruising, and small red dots (petechiae), generally heal within one to two weeks without needing treatment. Similarly, mild eye injuries like conjunctivitis and tiny bleeds in the white part of the eye (subconjunctival hemorrhages) also heal on their own pretty quickly.
If you have a severe eye injury, like a hematoma or a collection of blood beneath the outer layer of the eye (subperiosteal orbital hematoma), you may need to see an eye doctor (ophthalmologist) urgently. In some cases, if the injury results in the optic nerve getting squeezed or too much pressure inside the eye, draining the collected blood using a needle or a small surgical procedure (orbitotomy) might be necessary. However, in many cases, just monitoring the eye injury with regular follow-ups with the eye doctor does the job.
It’s important to note that mask squeeze is a trauma caused by pressure differences, not caused by tiny bubbles that form during decompression, which happens to divers. So, treatment doesn’t include giving oxygen or using a decompression chamber. But remember, decompression injuries can also occur along with mask squeeze, so be alert for any sign or symptom that might suggest this.
What else can Diving Mask Squeeze be?
Doctors usually diagnose the condition using a patient’s medical history, physical examination, and diagnostic images like X-rays or scans. However, the physician should also be mindful of the chance that the patient might be suffering from other injuries related to scuba diving, such as decompression sickness.
What to expect with Diving Mask Squeeze
The outlook is typically very good, with most people fully recovering. Even severe eye injuries tend to have great results in locations where eye specialist services are readily available.
Possible Complications When Diagnosed with Diving Mask Squeeze
Complications are uncommon, but they typically occur if severe eye injuries are not promptly recognized. Additionally, problems might arise if the patient also has decompression sickness. Everyone examining a patient should keep a watchful eye for these possibilities.
Preventing Diving Mask Squeeze
In most cases, the primary treatment is simply supportive care. So, the doctor’s main task is to offer reassurances to the patient. It’s also important for patients to follow up with their dive instructor for additional training. This can help to decrease the chances of similar injuries happening again in the future.
