{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:53:35Z","timestamp":1781574815306,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Hip arthroscopy is a minimally invasive procedure with rare complications that can occur due to air entry outside the joint space. Case Presentation: A 19-year-old patient underwent right hip arthroscopy with attempted joint venting. The next morning, she had pain in her right leg, neck, and chest with paresthesias over her hands and feet. A subsequent emergency department physical exam revealed crepitation of the lower extremities, abdomen, chest, and neck caused by air entrance during arthroscopy. The patient also reported blurred near vision. Additionally, the pupils were fixed, did not accommodate, and were dilated at 7 mm. Computed tomography scans revealed subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, and cervicofacial emphysema. Magnetic resonance imaging of the brain revealed a Chiari I malformation. The patient received four hyperbaric oxygen treatments. By the fourth treatment, near visual acuity had improved, but far visual acuity had worsened. Vision had returned to normal eight days after discharge. Conclusions: It is proposed that the patient\u2019s reduced near vision, accommodation paralysis, and fixed and dilated pupils were brought about by pneumomediastinum and cervicofacial emphysema, inhibiting the ability of the pupils to constrict, causing bilateral mydriasis and accommodation paralysis for near targets. Additionally, the subsequent transient myopic shift is a known complication of hyperbaric oxygen therapy, which increases the refractive index of the crystalline lens.<\/jats:p>","DOI":"10.3390\/jcm15124634","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:49:01Z","timestamp":1781570941000},"page":"4634","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Resolution of Pneumomediastinum, Cervicofacial Emphysema, and Internal Ophthalmoplegia with Hyperbaric Oxygen Therapy After Hip Arthroscopy: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1644-7074","authenticated-orcid":false,"given":"Samuel J.","family":"Thomas","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Indiana University School of Medicine, South Bend, IN 46617, USA"},{"name":"Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery M.","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Indiana University School of Medicine, South Bend, IN 46617, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshaal","family":"Kizilbash","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack H.","family":"Langford","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Indiana University School of Medicine, South Bend, IN 46617, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3802-648X","authenticated-orcid":false,"given":"Nicholas E.","family":"Kalafatis","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6664-8211","authenticated-orcid":false,"given":"Aumer","family":"Shughoury","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane M.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Department of Wound Healing, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Larson","sequence":"additional","affiliation":[{"name":"Department of Wound Healing, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew K.","family":"Marsee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Jordan","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Raza","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Wiarda","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Grossnickle Eye Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeela M.","family":"Alizai","sequence":"additional","affiliation":[{"name":"Department of Medical Ophthalmology, Michiana Ophthalmology and Headache, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5795-1144","authenticated-orcid":false,"given":"Mark M.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Indiana University School of Medicine, South Bend, IN 46617, USA"},{"name":"Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"402","DOI":"10.32098\/mltj.03.2016.18","article-title":"Complications in Hip Arthroscopy","volume":"6","author":"Nakano","year":"2016","journal-title":"Muscles Ligaments Tendons J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e474","DOI":"10.3928\/01477447-20160427-01","article-title":"Use of an Irrigation Pump System in Arthroscopic Procedures","volume":"39","author":"Hsiao","year":"2016","journal-title":"Orthopedics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"194","DOI":"10.4103\/0019-5049.177866","article-title":"Effects of irrigation fluid in shoulder arthroscopy","volume":"60","author":"Gupta","year":"2016","journal-title":"Indian J. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1093\/bja\/85.6.926","article-title":"Air embolism during anaesthesia for shoulder arthroscopy","volume":"85","author":"Hegde","year":"2000","journal-title":"Br. J. Anaesth."},{"key":"ref_5","first-page":"1","article-title":"Air Embolism Immediately Following Air Arthrogram in Hip Arthroscopy: A Case Report","volume":"8","author":"Ryan","year":"2024","journal-title":"J. Exerc. Sports Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102986","DOI":"10.1016\/j.eats.2024.102986","article-title":"Dry Knee Arthroscopy with Carbon Dioxide Insufflation for Anterior Cruciate Ligament Reconstruction","volume":"13","author":"Butt","year":"2024","journal-title":"Arthrosc. Tech."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2325967119837389","DOI":"10.1177\/2325967119837389","article-title":"Use of Air Arthrograms to Aid in Joint Distraction During Hip Arthroscopic Surgery Decreases Postoperative Pain and Opioid Requirements","volume":"7","author":"Hodax","year":"2019","journal-title":"Orthop. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1016\/j.arthro.2021.02.015","article-title":"Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy","volume":"37","author":"Mortensen","year":"2021","journal-title":"Arthroscopy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1378\/chest.103.5.1606","article-title":"Pneumomediastinum caused by subcutaneous emphysema in the shoulder. A rare complication of arthroscopy","volume":"103","author":"Lau","year":"1993","journal-title":"Chest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.jor.2017.03.009","article-title":"Subcutaneous emphysema after shoulder arthroscopy. A case report and review of the literature","volume":"14","author":"Kerens","year":"2017","journal-title":"J. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1186\/s13054-023-04563-x","article-title":"Early hyperbaric oxygen therapy is associated with favorable outcome in patients with iatrogenic cerebral arterial gas embolism: Systematic review and individual patient data meta-analysis of observational studies","volume":"27","author":"Fakkert","year":"2023","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.22462\/01.02.2022.7","article-title":"Hyperbaric oxygen for the treatment of severe subcutaneous and mediastinal emphysema after Renuvion\/J-Plasma therapy\u00ae","volume":"49","author":"Allen","year":"2022","journal-title":"Undersea Hyperb. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1001\/jama.1967.03130250090026","article-title":"Hyperbaric Treatment of Subcutaneous Emphysema","volume":"202","author":"End","year":"1967","journal-title":"JAMA"},{"key":"ref_14","unstructured":"U.S. Navy (2016). U.S. Navy Diving Manual, Naval Sea Systems Command. Rev. 7."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"197","DOI":"10.4097\/kjae.2016.69.2.197","article-title":"Unilateral postoperative visual loss in a patient undergoing hip arthroscopy in the supine position: A case report","volume":"69","author":"Lee","year":"2016","journal-title":"Korean J. Anesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1586\/17469899.2015.1057505","article-title":"Neuro-ophthalmology of type 1 Chiari malformation","volume":"10","author":"Shaikh","year":"2015","journal-title":"Expert Rev. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fernandez, A.A., Guerrero, A.I., Martinez, M.I., Vazquez, M.E., Fernandez, J.B., Chesa i Octavio, E., Labrado Jde, L., Silva, M.E., de Araoz, M.F., and Garcia-Ramos, R. (2009). Malformations of the craniocervical junction (Chiari type I and syringomyelia: Classification, diagnosis and treatment). BMC Musculoskelet. Disord., 10.","DOI":"10.1186\/1471-2474-10-S1-S1"},{"key":"ref_18","first-page":"e13482","article-title":"Acute Vertigo After CrossFit Workout in a Young Woman with Chiari I Malformation","volume":"13","author":"Rossettini","year":"2021","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.3174\/ajnr.A1089","article-title":"The oculomotor cistern: Anatomy and high-resolution imaging","volume":"29","author":"Everton","year":"2008","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_20","unstructured":"Ranson, S.W., and Clark, S.L. (1959). The Anatomy of the Nervous System: Its Development and Function, Saunders. [10th ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hajrovic, S., Bexheti, E., Dozic, A., Bexheti, S., Cetkovic, D., Maric Kujundzic, H., Simic, M., Milasinovic, S., Mircic, U., and Vitosevic, Z. (2026). Arterial supply of the interpeduncular part of the human oculomotor nerve. Front. Neuroanat., 20.","DOI":"10.3389\/fnana.2026.1758626"},{"key":"ref_22","unstructured":"Bajandas, F.J., and Kline, L.B. (1988). Neuro-Ophthalmology Review Manual, Slack Inc.. [3rd ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/2152-7806.153877","article-title":"Pupil sparing oculomotor nerve paresis after anterior communicating artery aneurysm rupture: False localizing sign or acute microvascular ischemia?","volume":"6","author":"Srinivasan","year":"2015","journal-title":"Surg. Neurol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hares, F., Kwong, C., Singhal, S., Starr, J., and Domico, M. (2025). 827: Transient anisocoria due to subcutaneous emphysema in a child with status asthmaticus. Crit. Care Med.","DOI":"10.1097\/01.ccm.0001101972.19037.23"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e27887","DOI":"10.1097\/MD.0000000000027887","article-title":"Anisocoria after scopolamine transdermal patch contamination: A case report","volume":"100","author":"Joo","year":"2021","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"367","DOI":"10.34172\/aim.34254","article-title":"Bilateral Mydriasis in a Post-parotidectomy Patient: A Case Report","volume":"28","author":"Daneshi","year":"2025","journal-title":"Arch. Iran. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100390","DOI":"10.1016\/j.adoms.2023.100390","article-title":"Transient benign unilateral dilated pupil after pathologic oral surgery under general anesthesia: A case report","volume":"9","author":"Farahmand","year":"2023","journal-title":"Adv. Oral Maxillofac. Surg."},{"key":"ref_28","first-page":"8884009","article-title":"Recurrent Self-Induced Nontraumatic Orbital Emphysema Causing Orbital Compartment Syndrome with Optic Nerve Dysfunction","volume":"2021","author":"Cutting","year":"2021","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/j.jcin.2023.12.026","article-title":"Bilateral Mydriasis Due to Air Embolism","volume":"17","author":"Du","year":"2024","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cervenak, V., Vsiansky, V., Cvikova, M., Brichta, J., Vinklarek, J., Stefela, J., Harsany, M., Hajek, M., Herzig, R., and Kouril, D. (2024). Cerebral air embolism: Neurologic manifestations, prognosis, and outcome. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1417006"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"245","DOI":"10.28920\/dhm49.4.245-252","article-title":"The myopic shift associated with hyperbaric oxygen administration is reduced when using a mask delivery system compared to a hood\u2014A randomised controlled trial","volume":"49","author":"Bennett","year":"2019","journal-title":"Diving Hyperb. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0014-4835(05)80105-8","article-title":"Nuclear light scattering, disulfide formation and membrane damage in lenses of older guinea pigs treated with hyperbaric oxygen","volume":"60","author":"Giblin","year":"1995","journal-title":"Exp. Eye Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1097\/OPX.0000000000000705","article-title":"Myopic Shift during Hyperbaric Oxygenation Attributed to Lens Index Changes","volume":"92","author":"Evanger","year":"2015","journal-title":"Optom. Vis. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Zhou, Y., Jia, Y., Wang, T., and Meng, D. (2023). Adverse effects of hyperbaric oxygen therapy: A systematic review and meta-analysis. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1160774"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ijscr.2018.01.018","article-title":"Management of extensive surgical emphysema with subcutaneous drain: A case report","volume":"44","author":"Tran","year":"2018","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"17","DOI":"10.21037\/shc.2020.03.08","article-title":"Postoperative subcutaneous emphysema: Prevention and treatment","volume":"5","author":"Lodhia","year":"2021","journal-title":"Shanghai Chest"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4634\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:16:02Z","timestamp":1781572562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4634"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124634"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124634","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}