Dry Eye Symptoms and CPAP Therapy – An Ophthalmologist’s Perspective

The causes of red eyes can often be a mystery. Patients reported dry eye problems induced by CPAP machines. Obstructive sleep apnea disorder causes interruption of breathing during the night at short repeated intervals. The low blood oxygen saturation levels that result from it cause drowsiness and fatigue during the day. It is often accompanied by very loud snoring and the affected person can wake up with “air hunger” several times a night. Sleep apnea can cause serious health and mortality problems if not treated over time. Continuous positive airway pressure, or CPAP, is used as a standard of care treatment. A CPAP keeps the upper airways open by providing a constant flow of air delivered through a face mask or “nasal pillows worn during sleep. Compliance is often reported as low with the CPAP machine due to various problems. Solving these problems is critical for your well to be and continued use of a CPAP machine.

Eye problems reported with CPAP therapy include dry eyes, red eyes, swollen eyes (skin around the eyes) and redness of the eyelids and face around the eyes. Each of these symptoms should be discussed with the doctor who prescribed CPAP therapy and, if necessary, you can request further help from your optometrist.

You may be inclined to believe that the origin of your dry eye, eye inflammation, pinkeye appearance or swollen eye is caused by an allergy to the mask. Most masks today are latex-free and made with silicone polymers. The incidence of true silicone allergy is almost negligible. Eye symptoms can be caused by a number of factors.

– A mask may be too narrow by exerting pressure on the face

– A mask may be too loose causing air to flow through the eye at night causing a dry eye and simulating dry eye syndrome. The main difference is that the CPAP-induced dry eye will be worse on waking and will improve as the day progresses while Dry Eye Syndrome usually gets worse as the day progresses.

– A worn or defective mask may come out.

– Worn nasal cushions may begin to blow air towards the eyes.

– It is assumed that air pressure can induce dry eyes by forcing the air through the tear openings. The occlusion of the Punctal spine by an ophthalmologist can be tried with temporary spikes of collagen to exclude this possibility.

-Patients with sleep apnea also have an increased frequency of floppy eyelid syndrome. Floppy eyelid syndrome is a lax upper eyelid that reverses easily (by capsizing). Patients with untreated sleep apnea often sleep on their side down on a pillow in an unconscious attempt to keep their airways open. Due to a loose eyelid, the lid lifts exposing the conjunctival tissue lining. This constantly rubs on the pillowcase causing mechanical irritation and exposes the fabric to all allergens present on the pillowcase. Conjunctival tissue can become chronically inflamed with papillary conjunctivitis and red eyes upon awakening. Sleep apnea treatment will help solve the problem as there will be a reduction in face-down rolling. There is no more hypoxia (oxygen deprivation) and the mask itself provides behavioral changes in sleep posture since it protrudes from the face. Treatment of any remaining dry eye symptoms is still essential.

– Occasionally an individual will already have dry eyes or sleep with partially open eyes, which will make the masks that lose more symptomatic. Treatment of primary dry eye syndrome is essential in this case and should be done in consultation with your ophthalmologist.

– Some people may be more sensitive to the pressure of the mask under the eyelids on a repetitive basis and may benefit from using differently shaped masks on subsequent nights. The fit of a mask is so important that it may not be an option and the doctor may need to use prescription ointments (usually after removing the mask).

– You may need additional treatment from your eye doctor for dry eyes, artificial tears such as Thera Tears, a few prescription eye drops.

– Your optometrist may also prescribe an eye treatment for red-eye-induced conjunctivitis with eye medications such as Patanol.

Discuss your problems with the doctor. Simple measurements can be all you need. Re-adjusting the mask straps, replacing a mask or changing the type of mask may completely resolve eye symptoms. If you can’t solve your problems after the visit, the next step should be an eye exam with your optometrist.

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