Diplopia due to mask barotrauma.

BACKGROUND: Scuba diving is a very popular and safe sport. Occasionally divers will suffer an injury from barotrauma, decompression sickness or an arterial gas embolism. The history and physical examination are important when determining the etiology of the injury and its subsequent treatment.

OBJECTIVES: This article will help readers identify key components of the history and physical examination in a patient to help differentiate between and injury caused by barotrauma or arterial gas embolism.

CASE REPORT: This is a case of a diver that was initially felt to have an arterial gas embolism after scuba diving. After obtaining further history and performing a detailed physical exam it was determined that his diplopia was due to barotrauma from his mask. This was confirmed by an orbital computed tomography (CT) scan.

SUMMARY: Scuba diving is a very safe sport. When injuries occur it is important to obtain a careful history and physical examination to determine the exact cause of the injury because treatments vary according to the type of injury. In this case, the history and physical examination showed that the only neurologic sign the patient had was diplopia, which is not consistent with a diagnosis of arterial gas embolism. The CT scan helped with the diagnosis because it proved the patient had an orbital hematoma causing his proptosis and double vision.