CPAP related red eyes

[willi7m]

Can CPAP air entering through the nose pass up the tear ducts and exit the lacrimal punctum between the closed eyelids and the cornea/conjunctiva when sleeping?  If this is the case, is there risk of long term damage to the lacrymal system and persistent tearing?

My mask fits well, and my CPAP pressure is nominal (8.2), but every morning  my eyes are invariably red and itchy, and the lids are a bit swollen.  I have no am discharge/crusting, and no history of ocular allergies or external eye conditions.

This is a real problem for me, and I need the CPAP. Patanol and pm lacrymal ointment have been of no help.

  

[John C Hagan III, MD, FACS, FAAO]

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[Luan08]

I didn't relate the horrible red bloodshot eyes to the CPAP, but now that my eyelids are swollen, itchy and my eyes are staying red, and the only thing that's changed is I've been wearing a cpap mask for the past 8 nights...I guess that's what's happening.  I called the sleep clinic, talked to a nurse and she told me to stop the cpap for a couple nights to see if it got better. I've gone one night without the cpap...and my eyes are not recovered, I'm going another night tonight...and hopefully tomorrow they will start getting better.  Hopefully this is not a permanent damage!!!  I look just awful!  I've been using "Opcon-A" which seems to relieve some of the itching and redness.  If it's not better tomorrow, I'm going to see a doctor.  

[CPAP_Eyes]

I have finally found someone (both willi7m and luvyshaw) that has described the same or similar problems I have been having for years. The main difference is that,  I DO have somewhat severe environmental allergies (grass, trees, weeds, pet dander, dust, dust mite, cockroach, etc.).  Sometimes when using the CPAP, even with C-Flex, and heated humidier, I may have an Allergy flair-up during the night, and wake up with severely irritated eyes, sometimes with crusted mucus. in them.  At the same time, I also experience, nasal congestion, runny nose, and past nasal drip. Only my left eye is  affected about 95 percent of the time,  and my lids usually become very painful, swollen, irritated, sensitive, and tearful.  That temporarily disables me from being able to drive safely.
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I feel my tear duct got damaged years ago from the required high pressures of 16 and 18 cm with a CPAP for several years..  But, almost all medical professionals want to attribute it to the allergies only,  and / or a leaky mask only! I have used scores of Prescription antihistamines, decongestants, eye drops, nasal sprays, saline flushes, have reduced CPAP pressures, and used different style mask over the past seven years!  These help moderate symptoms, or recover from occurrences, but do not prevent them.
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I wish more research would be done in this area.  Maybe then, more of the medical community would come out of denial, and realize that tear duct problems are a possible side effect of the "Holy Grail" Sleep Apnea Treatment!

[John C Hagan III, MD, FACS, FAAO]

As I said look into the new much smaller CPAP masks.

JCH MD

[luvyshaw]

I am relieved and alarmed that I'm not the only one having eye problems using my c-pap. My eyes have been drying out and the eye lid is sticking to my eyeball. When I try to open my eyes it scracthes my cornea, if it scracthes it bad, my eye is painful and tearing all day. It seems to be doing it every night and I feel that it it is effecting my vision, which is bad enough as it is. I started using the PM ointment, but with limited success.There must be an eye specialist that can give us the chioce between going blind and having a heart attack.

[John C Hagan III, MD, FACS, FAAO]

Yes its possible. I would suggest seeing an oculoplastic surgeon to examine the lower segment of the tear duct opening (valve of hasner) to see if there is a problem there.  I am not an expert on CPAP tubing but I have had seveeral patients with this problem solve it by going to micro/mini masks. Its a common problem. Disucss it with your pulmonary MD also.

Find a oculplastic surgeon at www.aao.org

JCH MD