Case Report on Mr.S.T.

Diagnosis

Nitrogen corneal bubbling

Discussion

In this interesting case, the patient had been diving to a greater than safe acceptable limits, for a longer than safe time and ascended to the surface faster than he should have done, even for lesser depths.

This patient was 36 years old, white, male and a professional abalone diver. He was fitted with hydrophilic contact lenses to allow him better vision whilst diving. However, he wasn't wearing them with this last dive.

At this visit, the patient did find that he was having some discomfort of the shoulders and elbows, commenting that perhaps he had "come up a bit fast."

Ophthalmoscopic viewing of the fundi repeatedly showed no signs of any vessel or haemodynamic irregularities. He reported that he had been "working a good area" and then realised he was running late to travel to Adelaide for his optometric and other appointments he had. When asked if he had problems making the ferry connection between Kangaroo Island and where he was in the mainland, he replied that he didn't travel that way but by light aircraft. It was obvious that he was exhibiting symptoms of Decompression Sickness (DCS) or "The Bends", brought on by diving depth and ascent rate, and exaggerated by flying with an atmospheric pressure less than at sea level.

He had been diving to a depth of 125-130 feet for an extended period of 5-5½ hours using a "hookah" airhose to supply compressed air from the surface rather than compressed air tanks carried on the back, and had neglected the standard decompression tables normally used to control the rate of ascent. All of these factors had led to gas emboli forming not only in his joint spaces (the pain referred to as "The Bends"), and his bloodstream, but also evident in his corneae. The suggestion to him that the local main hospital (1 kilometre away) would be phoned to advise the hyperbaric unit to expect him there shortly, was met with refusal. He stated that 2 or 3 cans of "Fosters" would numb the pain and get him through the difficult period.

In this case, staining with fluorescien showed there to be puntate epithelial changes corresponding to the sites of the gas emboli as they reached the surface of the corneae. There was no uptake of dye into the deeper epithelial tissues of the stroma.

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