Eyes puffed-out after dive.

[The Iceni]

Durrr:loopy:

 

[DocVikingo]

As with Paul, I'd appreciate hearing the details of any further medical follow up, although your post does not suggest that you have as yet scheduled any additional visits.

I would also add that as is lamentably frequent in the Diving Medicine forum, a number of terms that are not likely familiar to you have been bandied about. If you would like clarification of any of these, please don't hesitate to post your question or to e-mail me directly.

In the meantime, here's a very simple illustration of the facial sinuses that may be of use: http://my.webmd.com/encyclopedia/article/4115.15098

Best regards.

DocVikingo

 

[Rebekka]

Hi all,
The same thing happened to me after a night dive last December except that it was just one eye that was affected. There was rapid swelling at the area directly underneath my right eye within half an hour after surfacing. As I was stuck on a tiny island with the nearest medical facility 2.5 hours away by boat, I resorted to using an ice pack on the swollen area. Luckily, the swelling went down by the next day.

What was puzzling was that there was absolutely nothing during the dive that could have triggered the swelling. It just happened. Anyway, just to be sure that I could continue diving, I went to the mainland to see an eye specialist at the local hospital. He examined my eyes and diagnosed it as a probable allergic reaction. I was to take Cetinzine Hydrocloride tablets should the swelling recur. I started diving again the following day and fortunately all was well.
Best regards,
Rebecca

 

[Laurence Stein DDS]

Is there crepitis with "skin bends?" Or just a rash?

Now we have two divers reporting similar conditions. I just don't remember if crepitis can be present.

Larry Stein

 

[The Iceni]

Laurence Stein DDS once bubbled...
Is there crepitis with "skin bends?" Or just a rash?

Now we have two divers reporting similar conditions. I just don't remember if crepitis can be present.

Larry Stein

Hi Larry,

Crepitus is a clinical sign which is instantly recognisable because it has the distinctly unpleasant feeling of "popping" under contact pressure, as the air is moved by the finger tips between the subcutaneous tissue planes under the whole skin. It has been described as similar to popping crinkle wrap - the plastic bubble-filled material used to wrap fragile items, protecting them during transport.

It is the one classical clinical finding that confirms the diagnosis of subcutaneous (or surgical) emphysema.

(No relationship whatsover to the lung disease emphysema apart from the fact that both are characterised by air being trapped where it shouldn't be!).

It is a "gross" or macroscopic finding - where quite large quantities of gas have found their way under the skin. Nowadays this is usually derived from the overpressurisation of an anatomically normal gas-filled cavity with a (resulting) defect in the integrity of the retaining tissues ;- allowing gas to escape either from the chest or, as in this case perhaps, the sinuses.

Gas gangrene is another (now thankfully uncommon) cause.

If I remember rightly "Skin bends" is a diagnosis which is caused by microscopic bubbles forming within the capilliaries of the skin itself. These cannot be felt or seen but cause microscopic damage, with the clinical signs of a rash (and blistering?) and symptoms of severe itching due to the microscopic damage. (Itching, in reality, is a form of low grade pain.)

Although I may stand corrected;-

• Subcutaneous emphysema is caused by barotrauma.
• Skin bends are a form of decompression injury.

I hope that helps to differentiate between the two.

 

[Laurence Stein DDS]

I have felt crepitis during root canal therapy. Some of the gas liberated by the irrigating solutions escaped out the end of a youngster's upper front tooth. The lip swelled in seconds and there was a crackly feeling. I just wasn't sure if skin bends would produce the same effect. Thanks for the clarification.

Regards,

Larry Stein

 

[The Iceni]

Hi Larry,

Just re-read my post. It reads like a stern lecture!

Not intentional.

 

[Laurence Stein DDS]

Doc Paul,

You didn't offend me with your "stern" lecture. Heck my wife is more stern with me!

I have felt crepitis and it does feel strange. I simply didn't know if it is a sign of skin bends. Now I have to stop groping the women on the boat looking for skin bends! I can't use that excuse any more.

Hey, I don't do too bad for a "toothdoc" in the medicine department and you guys are giving me quite and extra education. I'm enjoying it.

Regards, hope you get some sleep tonight.

Larry Stein

 

[fredriam]

I just returned from diving the Turks & Caicos Islands - 26 dives in 5&1/2 days and nary a sign or symptom affecting my eyes or sinuses; I took extra care to avoid any sinus congestion. So duly noted as an anomalous reaction in my log book - someone suggested chopped-up jelly fish bits from boat props getting into my mask causing an allergic reaction - diving goes on. Thanks all.

A