Bruising below eye after Sinus Barotrauma

[DavidWo]

Ascending from a 20 min dive to 12msw I experienced pain in the maxillary sinus at 5msw. I descend to 8msw where the pain disappeared and ascend more slowly. I experienced discomfort after 10min I reach 1.7msw where the sinuses cleared.

Upon surfacing I experience slight tingle in the cheek and glum and subsequently bruising has appeared below the eye (really black now after two days).

Has anyone heard of getting a "black eye" from sinus barotrauma? My limited understanding of the maxillary sinus is that it drains through an opening at the top which if blocked could possibly blow out below the eye.

Any comments on what could have happened would be appreciated or if you have experience something similar.

 

[Griff]

HI David

Sinus barotrauma of ascent is not uncommon and is normally caused by simple conditions such as colds which can block the sinus cavities and eustacian tubes with excessive mucus.

This mucus plug can trap any breathing gas in these specific cavities and thus when you ascend the gas cannot escape via its natural orifces or confines. If the gas is a substantial amount then it is possible that it can cause a black eye or even enter the orbital cavity (eye socket).

If you have taken a nasal decongestant prior to diving (not a good idea anyway) for a cold it is likely that it wore off and trapped the gas.

The fact that you say you felt tingling down one side of your fac shows that the barotrauma has pressed on the fifth cranial nerve
Your treatment should include antibiotics for possible infection as well as some simple decongestants.

If you have no explaination for the barotrauma it may be an idea to consult with an ENT (ears nose throat) specialist to see if you have any possible chronic nasal obstructions.

Hope this helps

 

[Griff]

Thinking of it again, The black eye can be caused by an even simpler explaination. That of a mask squeeze due to the fact that the nose is blocked and cannot therefore equalize the air space in the mask.

 

[John Reinertson]

The tingling, if localized to the area including upper lip, part of the cheek and gum, suggests a peripheral nerve injury, specifically to the infraorbital nerve, which passes through the "roof" of the maxillary sinus. The bony layer between the orbit (the bony eye socket) and the maxillary sinus is paper thin and can be ruptured by sudden increased pressure. Most commonly, blunt force (punch or other blow to the eye) causes these "blow-out" fractures, but they could as easily occur the other direction with a major squeeze. This can then push the fractured bone against the nerve and cause numbness and weakness of some of the facial muscles. The Black eye you describe suggests a blow-out fracture, as otherwise maxillary sinus pressure can't create bleeding in the eye socket.

This means that snot has come in contact with broken bone and blood vessels and means risk of infection.

See your doc, and get someone to carefully evaluate your sinuses. This is not a common condition, and is not to be dismissed lightly.

John