Dental, Mask, and Eye Barotrauma

Dental barotrauma can occur during descent or ascent during deep-water diving, when pressure in the air spaces at the roots of infected teeth or adjacent to fillings changes rapidly and causes pain or tooth damage. The affected tooth may be tender when percussed with a tongue blade.

Mask barotrauma occurs when the pressure in the space behind a diver's face mask is not equalized during descent (ie, by exhaling into the mask). The resulting relative vacuum can lead to local pain, conjunctival hemorrhage, and ecchymosis of the skin enclosed by the mask. Retro-orbital hemorrhage is possible but rare.

If retro-orbital hemorrhage is suspected, complete eye examination (including visual acuity, extraocular movements, and intraocular pressure measurement) and head CT are performed. Mask barotrauma may be avoided when pressures are equalized within the face mask by exhaling from the nose into the mask.

Eye barotrauma occurs when small air bubbles are trapped behind hard contact lenses. The air bubbles can damage the eye and cause soreness, decreased visual acuity, and halos around lights. A screening ophthalmic examination should be done to exclude other causes. Pressure behind goggles cannot be equalized and may result in periorbital barotrauma, (ie, hemorrhage around the orbit), so goggles should not be used for diving.