02 November 2019

Air through Eye Tear Duct - Introduction

I have not failed. I've just found 10,000 ways that won't work.”
- Thomas Edison (American Inventor & Businessman – 1847 - 1931)

The issue of air coming through the eye tear duct or nasolacrimal duct and coming out of the eye was the hardest and most challenging CPAP issue that I had to overcome. Air from the machine kept coming through the eye tear duct and waking me constantly throughout the night. This side effect is also known as nasolacrimal air regurgitation into the eye or CPAP-associated retrograde air escape via the nasolacrimal system (CRANS).

Singh NP, Walker RJ, Cowan F, Davidson AC, Roberts DN. Retrograde air escape via the nasolacrimal system: a previously unrecognized complication of continuous positive airway pressure in the management of obstructive sleep apnea. Ann Otol Rhinol Laryngol. 2014;123(5):321-324. doi:10.1177/0003489414525924


I would wake up in the morning with terrible, painful red sore eyes as well as being totally exhausted. In addition, I did not look forward to going to sleep at night as I knew each morning I would wake up with the same pain and suffering as the previous morning!

The CPAP air issue arose due to having an eye dacryocystorhinostomy (DCR) surgery in 1996 on my left eye. Later in 2015, I had the same surgery performed on my right eye. DCR surgery opens up a new channel or duct so that the tears can flow down from your eye to your nose. Surgery is necessary due to a blocked tear duct which results in your tears flowing down your cheeks. Note that air may also come through the eye tear duct from having a faulty valve in the tear duct which is letting CPAP air through or from having a Lester-Jones tube (LJT) insertion.

Further information is available in this Research Paper.

To make overcoming the eye tear duct issue more difficult was that I wanted to use a nasal mask as it was my “perfect” mask and not a total face mask as other people had advised. I thought there must be a way of sleeping with any mask that a person wants to use including nasal pillows or a full face mask. Details of my "perfect" mask being a nasal mask are on the blog post Stop CPAP Mask Problems and Issues.

It was nearly impossible to overcome the air through the eye tear duct issue using pressure of up to 17 cmH2O as well as many other CPAP side effects and issues caused by the sleep apnea machine. Think of how high Mt Everest is and add 3,000 to 4,000 feet onto the top. That is the mountain I had to climb. It is the closest thing to impossible that I have had to deal with in my life! Details are on the blog page Secrets to Success: Answer is FREE.

“It always seems impossible until it’s done”
Nelson Mandela (South African Statesman – 1918 – 2013)

Hundreds of different settings on the CPAP and Bilevel or BiPAP machines were tried to overcome air through the eye tear ducts and coming out of the eyes as well as many other issues. I had some of the hardest and most difficult days of my life from when I was diagnosed for obstructive sleep apnea in 2010. Still I persevered as I was determined to succeed using a nasal mask. You can see the Bilevel settings that I use on Different Bilevel Settings Example.

In addition, I knew that I may need to use the sleep apnea machine for 40 years or more and I wanted to be comfortable and enjoy sleeping. From my personal experience, a total face mask is not the answer for many people as the sleep medical specialists and equipment suppliers may advise. More details on the next blog post CPAP Air coming out of the Eyes.

Fortunately, just seven years later in 2017, I finally conquered and stopped the air coming through both of my eye tear ducts every day using a nasal mask with pressure up to 17 cmH2O. To do so, I had to learn how the various sleep apnea machines and sleep apnea therapy truly worked from having no knowledge whatsoever. I made plenty of mistakes in finding the answer. When I look back some were just basic mistakes. Hindsight is always a wonderful thing.

Incredibly, whilst taking seven years to work out what to do, the actual answer for most people is SIMPLE! It is not complex as the sleep medical specialists would have you to believe and you do not need to use a total face mask. It was after I had two Aha moments that I came to realize what the answer was. The answer had been staring me in the face for a long time; however I could not see it!

Read more about Aha moments at: 

Since originally writing this blog post, in early 2021 I began using a very high starting IPAP of 18.2 cmH2O and EPAP of 12.8 cmH2O (inhale and exhale pressure) which may cause air coming out the eyes. Top pressure during the night may be more than 20 cmH2O! This was essential to stop hypoxia (oxygen desaturation) and sleep disordered breathing causing the symptoms of Dementia. In addition, eye cataracts are associated with Alzheimer's Dementia.

More details are on the blog post: 

Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues

Over the next few blog posts, I will detail how to overcome the issue of air through the eye tear duct and coming out the eyes using any sleep apnea mask and how two Aha moments gave me the answer. These posts are:

CPAP Air coming out of the Eyes

How to Stop Eye Tear Duct Air Regurgitation? 

CPAP Settings to Stop Air coming out the Eyes

CPAP Air out Eyes and Tear Ducts: Other Options

CPAP Air out Eyes and Tear Ducts: Other Options (Part 2)

Should you be having side effects and issues with your sleep apnea therapy; CHANGE what you are doing so that you can wake up feeling refreshed and energized each day.

“Have courage. Be adventurous and Go for it! Overcome your fear.” 
- Mrhelpful