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Mask Squeeze

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Other Names

  • Mask Squeeze
  • Mask Barotrauma
  • Facial barotrauma


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


Subconjunctival petechiae and hemorrhage from mask barotrauma[1]
  • 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


  • 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

Risk Factors

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

Differential Diagnosis

Differential Diagnosis Dive Medicine

Clinical Features

Mask squeeze with significant periorbital ecchymosis and moderate subconjunctival hemorrhage[2]
  • 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


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


  • No classification exists at this time



  • 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


  • 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

Rehab and Return to Play


  • 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

Complications and Prognosis


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


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

See Also


  1. Image courtesy of dan.org, "Mask Squeeze (Facial Barotrauma)"
  2. Image courtesy of https://sonorandeserteye.blogspot.com/, "Scuba Diving Mask Squeeze
Created by:
John Kiel on 22 June 2022 14:16:42
Last edited:
25 July 2022 19:54:54