Anterior segment complications secondary to continuous positive airway pressure machine treatment in patients with obstructive sleep apnea.

BACKGROUND

Obstructive sleep apnea (OSA) is a disorder that, when left untreated, can have serious complications, mainly cardiovascular. OSA is commonly treated with a continuous positive airflow pressure (CPAP) machine. Patients using CPAPs routinely complain of dryness of the nose and eyes.

CASES: Case 1: A keratoconic woman, wearing gas-permeable lenses began therapy with a CPAP, and vascularized limbal keratitis (VLK) developed. She now wears soft lenses, compromising visual acuity, but preventing the VLK. Case 2: A man with 20/20 visual acuity in the right eye (O.D.) and hand motion in the left eye (O.S.), presented with recurring corneal ulcers O.D. after starting treatment with a CPAP. Case 3: A man with pellucid degeneration started using a CPAP, which increased his complaint of dryness with his lenses. He subsequently had 2 occurrences of bacterial conjunctivitis.

CONCLUSION

It is unclear if the complications seen in these cases come from leakage of air into the eyes causing drying, from bacteria trapped under the mask being forced up into the eyes, or from air passing from the nose into the eye via the nasolacrimal duct. In the care of these patients, being aware of complications, suggesting nighttime lubricants, and knowing the alternatives to CPAP could help maintain ocular health and successful lens wear.