Mask Squeeze

Other Names

• Mask Squeeze
• Mask Barotrauma
• Facial barotrauma

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Background

• This page refers to 'mask squeeze', a form of diving barotrauma resulting from a failure to equalize the air space created between your mask and face

Epidemiology

• Epidemiology of mask squeeze is not well described in the literature
  • Most cases likely go unreported

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Pathophysiology

Subconjunctival petechiae and hemorrhage from mask barotrauma

• See: Dive Medicine Main
• General
  • Occurs when air space between mask and face is not equalized with water pressure during dive
  • This creates a negative pressure on the rea of the face covered by mask
  • Think "face stuck in suction cup"
  • Generally a relatively benign conditions
  • More common in new divers
• Mask equalization
  • Blockage of nose with congestion, clips can interfere
• Injury can occur to
  • Eyes
  • Tissue covered by mask including forehead, nose and periorbital tissue

Etiology

• During descent
  • Divers need to equalize air space in mask during descent
  • Failure to equalize will create unequal pressure between air space in the mask and the vascular pressure of blood vessels in the face
  • This pressure difference results in varying degrees of facial barotrauma

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Risk Factors

• Diving related
  • Inexperienced diver
  • Mask with high internal volume of air
• Ophthalmology
  • Possibly, recent eye surgery
  • Preexisting glaucoma

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Differential Diagnosis

Differential Diagnosis Dive Medicine

• Barotrauma of descent
  • Otic Barotrauma: "ear squeeze"
  • Sinus Barotrauma: "sinus squeeze"
  • Mask Squeeze: air in the mask decreases in volume during a dive, creating negative pressure
  • Barodentalgia: trapped dental air causing squeeze
• At depth injuries
  • Oxygen Toxicity: harmful effects of breathing oxygen at higher partial pressures than normal
  • Nitrogen Narcosis: toxic effects of breathing nitrogen-containing gases while at depth
  • Hypothermia: decrease core temperature with prolonged exposure to cold water
  • Carbon Monoxide Toxicity: CO toxicity typically results from a faulty air compressor
  • Caustic Cocktail: Inhalation of absorbent material used to scrub CO2 mixes with water
• Barotrauma of ascent
  • Pulmonary Barotrauma: occurs when diver breathing compressed air ascends too rapidly
  • Decompression Sickness: Dissolved nitrogen comes out of solution, forms bubbles in blood and tissue ("the bends")
  • Arterial Gas Embolism
  • Alternobaric vertigo
  • Facial baroparesis (Bells Palsy)
• Other
  • Immersion Pulmonary Edema: also termed swimming induced pulmonary edema
  • Salt water aspiration
  • Submersion Injury: includes drowning, near drowning

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Clinical Features

Mask squeeze with significant periorbital ecchymosis and moderate subconjunctival hemorrhage

• History
  • Tends to occur in new divers
  • Patients will report redness or engorgement of blood vessels in eyes, cheeks, periorbital tissue
  • Facial pain is often mild
  • Visual disturbances or dysfunction are rare
• Physical Exam
  • Periorbital ecchymosis
  • Conjunctival hemorrhage
  • Some swelling may be noted
  • Petechiae on the eyelids
  • Rarely, retrobulbar hemorrhage (proptosis, decreased visual acuity, limited EOM increased IOP)
  • For eye exam, be sure to document visual acuity, EOM, PERRLA at a minimum
• Special Tests

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Evaluation

• The diagnosis is made clinically
  • Imaging can be considered if there is evidence of a significant eye injury

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Classification

• No classification exists at this time

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Management

Nonoperative

• Indications
  • Most cases
• Expectant management
  • Most cases will resolve spontaneously without intervention
  • Essentially, these bruises are self limited
  • Duration of symptoms typically 1-2 weeks
• Symptom management
  • Cold compress
  • Analgesics
• Important to exclude eye-threatening conditions
  • Consider imaging (CT, US), tonometry if clinically indicated
• Ophthalmology consultation or ED referral indicated if
  • Hyphema
  • Eye pain
  • Blurred vision
  • Visual field loss
  • Evidence of retrobulbar hemorrhage
  • Ocular compartment syndrome
• Not indicated
  • Oxygen therapy
  • Hyperbaric Oxygen Therapy

Prevention

• See: Prevening Diving Injuries
• Preventing mask squeeze:
  • Keep nasal passageways open during descent by blowing small amounts of ear through nose every time you equalize ears
  • Exhale through nose
  • Wear properly fitted mask; should seal to face and not fall off even without the strap in place

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Rehab and Return to Play

Rehabilitation

• There are no rehabilitation guidelines

Return to Play/ Work

• Condition is self limited
• In uncomplicated patients, divers can resume when symptoms have resolved
  • Typically this occurs in 1-2 weeks

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Complications and Prognosis

Prognosis

• Prognosis is generally excellent
• Rarely, patients will have significant eye complicatinons

Complications

• Complications are rare but include
  • Hyphema
  • Retrobulbar hemorrhage
  • Ocular Compartment Syndrome

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See Also

• Dive Medicine Main
• Environmental Main
• HEENT Main

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