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Dry Eyes Cause CPAP Users Much Sorrow

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A new study from Italian researchers suggests that Dry Eye Disease (DED) may be an overlooked complication of PAP machine use. According to the American Optometric Association, Dry eye disease occurs when a person is either not making enough tears to moisten the eye, or when the tears they make have the wrong chemical composition to support eye health. Over time, the dryness irritates the eye and eyelid, causing vision damage and other issues.

Normally, DED is caused by medications like antidepressants or certain blood pressure drugs, by excessive exposure to the sun, wind, dust, and dry environments, or by autoimmune conditions. In the recent study, there was also a strong correlation with CPAP use.

Researchers analyzed data on more than 330,00 patients in an IBM database. They found that while none of the patients had dry eye disease at the beginning of their CPAP use, within 3 years 10.3% suffered from DED. This was about twice the rate of DED as in the general population. CPAP users with T2D, on medications that cause dry eye, and who had used the CPAP longer were at greater risk.

The researchers suspect the issues are caused either by leakage from poor-fitting masks or because, for some people, the air from the CPAP can leak out the tear ducts, drying out their eyes as they sleep.

What this means for you or your practice

This research has several important implications for patients and providers:

For Patients

  • If you’re a CPAP patient and experience dry eyes, talk to your medical team. You may need a better-fitting mask.
  • If you’re suffering from dry eyes, see your ophthalmologist as well. There are therapies available, but you need to have your eyes evaluated.
  • Finally, remember that there are PAP alternatives. If the side effects of the PAP are making it hard for you to comply with treatment, talk to your team about a different device. For instance, many people tolerate oral appliances better than PAP machines.
  • When you’re checking in with patients on PAP therapy, ask about dry eyes. They may not realize that this is a common side effect and that there are treatments available.
  • When you see a patient who is having trouble complying with PAP therapy, question them to see if dry eyes was one of their issues. If it is, talk to them about mask fit, tear ducts, and alternatives.
  • Remember that when our patients have trouble complying with therapies, it’s often because the side effects outweigh their perceived benefits. Don’t scold, listen with compassion and help them develop workable solutions!
  • If you’d like more information on how interventions like an oral appliance can help patients who can’t tolerate PAP therapy, register for one of my sleep seminars! There are many great treatment options for OSA patients, with more becoming available all the time.