Non-traumatic Subperiosteal Orbital Hemorrhage Secondary to Barotrauma

Abstract

Purpose: To report a case of non-traumatic subperiosteal hemorrhage (NTSOH) secondary to barotrauma.

Material and methods: Observational case report.

Results: A 42-year-old female presented with right proptosis with bilateral petechial lid hemorrhages, chemosis and diplopia following scuba diving. This occurred in the context of a tight facemask resulting in ‘mask squeeze’, and performance of Valsalva maneuver to equalize ear pressure. Clinically, there were no signs of optic nerve involvement. Computed tomography (CT) demonstrated signs consistent with right subperiosteal hematoma adjacent to the orbital roof with inferolateral displacement of the superior rectus. Patient recovered well after being admitted for intravenous dexamethasone without surgical intervention.

Conclusion: NTSOH from barotrauma can result from ‘mask squeeze’ under a tight-fitting mask and exacerbated by use of Valsalva maneuvers. This may be prevented with frequent pressure equalization during diving.

KEYWORDS::

• Barotrauma
• Subperiosteal hematoma
• Orbit
• Hemorrhage

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

APPENDIX 1

Calculation of Water Pressure Below Sea Level

Liquid pressure can be calculated with the following formula:

p represents absolute pressure of liquid at h meters below sea level

p₀ represents atmospheric pressure at sea level (103,000Pa)

ρ represents density of liquid (sea water at 15°C = 1025 kg/m³)

g represents gravitational acceleration = 9.81m/s²

h represents depth below sea level (defined at 15m – depth at which our patient had injury)

Pressure unit conversion: 1 atm = 101,325 Pa

Therefore: