Climb out of the water on the ledge with the keyhole and use the GOLD KEY to open the gate on the left.
Swim through, fill Lara's air meter and then swim down and forward, then to the right. . .
. . . and right again.
Swim through the opening next to the serpent face panel into a small, dark room with closely spaced pillars.
The gate closes behind you, and another pesky fish appears. You may be able to kill it with harpoons, but this takes time (and air) so you're probably better off just ignoring it and using a health pack if necessary. Swim between the two pillars with the serpent faces.
Find the lever on the back of the first pillar and pull it to open the exit. If you're running out of air, continue around the first pillar and through the exit, which is located on the same wall as the entrance.
Otherwise, after pulling the lever, turn around and swim down along the left side of the second pillar to find a small medi pack on the floor.
Grab it and continue around the corner to the right. . .
. . . then right again, keeping the outer walls of the small room on Lara's left. Then swim forward through the exit.
Pulling that last lever also opened a trapdoor farther along the underwater passage. To reach it, continue swimming forward. (Unless you're about to run out of air, ignore the passage between the wooden support columns on the left. This leads back to the pool with the waterfall.)
At the end of the wide passage, swim straight up through the open trapdoor and head for the surface.
Swim to the right side of this pool and climb out of the water into the cave opening with wooden support pillars. Shoot the fish that followed you from the lever room and a second fish that just appeared.
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