08 March 2020

CPAP Air out Eyes and Tear Ducts: Other Options

“Many of life's failures are people who did not realize how close they were to success when they gave up.”
- Thomas Edison (American Inventor & Businessman – 1847 - 1931)

On the previous blog post CPAP Settings to Stop Air coming out the Eyes, I mentioned that I had DCR operations on both eye tear ducts and that air still comes out of my right eye. This was after adjusting the CPAP and Bilevel or BiPAP settings on the sleep apnea machine. On this Post, I provide details of Other Options that I have used to stop CPAP air coming out the eyes and air regurgitation through the eye tear ducts. Use these other options together with adjusting the CPAP and Bilevel or BiPAP settings where necessary. These other options have varying degrees of success which will be outlined below. 

For my left eye, no air comes out the eye when using maximum pressure up to 17 cmH2O. However, for my right eye, some air comes out the eye. This is due to the second eye DCR operation that I had in 2015 on my right eye being carried out slightly differently to the first eye DCR operation in 1996 on my left eye. The second operation used a temporary stent which is removed after a few weeks. The stent resulted in a wider tear duct than the first operation which causes an increase in the volume of air coming through the eye tear duct.  

Should you be thinking about or intending to have eye DCR surgery, I recommend you ask the Ophthalmologist, eye specialist to not put in temporary stents. By doing so, a person should have a smaller diameter in the tear duct. This will reduce the air coming through the eye tear duct and no air regurgitation into the eye should occur. Your sleep apnea therapy will be much easier in overcoming air through the eye tear duct especially when you consider that you may be using the sleep apnea machine for the next 30 to 40 or more years. 

Success rates of DCR surgery without stenting are excellent and studies have failed to show any clear benefit of stenting. When I last saw the Ophthalmologist in 2015, I was advised that “my left eye was perfect!” 

Furthermore, the practice is not entirely benign and stent-related complications include prolapse, corneal abrasion, canaliculi is, adhesions, false passage creation during intubation and cheese wiring of the puncta.

Feng Y, Cain J, Zhang J, Han X. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol 2011;46:6:521-527

The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis.

There are a number of different options available to stop air coming out the eyes and air regurgitation into the eye when you use CPAP. These other options may be critical to you should you have an issue including using a lot of pressure support or you need to use the humidifier due to nasal problems. 

As detailed in previous blog posts CPAP settings to stop air coming out the eyes and Stop eye tear duct air regurgitation, using a humidifier and/ or little pressure support will increase the air coming through the eye tear duct and out the eyes. This CPAP side effect may cause you a lot of eye pain and suffering and lack of quality sleep at night. 

1. Bilevel or BiPAP Auto adjusting pressure machine
Seriously consider obtaining a Bilevel or BiPAP Auto adjusting machine. This is a great option for many of you with CPAP air coming out the eyes and is one of The Secrets to Success should you be having issues using CPAP. It is a great option due to the various options on the machine in particular the TI Min and Max to control the time you inhale and pressure support of up to 10 cmH2O when compared to CPAP with only 3 cmH2O. This option is the best especially where you are using pressure greater than 12 cmH2O and/ or you are having issues with your sleep apnea therapy such as nose issues. 

From my personal experience, the issue of air coming out of the eyes can be resolved for most people by reviewing and optimizing the settings being used on their sleep apnea machine. 

2.  Swimming Goggles with medical gauze swabs inside each goggle 

Using medical gauze swabs inside goggles is my next preferred option as it stops air coming through in my right eye and is cheap. The cost was only $2.00 for the googles and will save money compared to other options. The medical gauze is soft and molds to the shape of your eye and together with the googles puts just a little pressure on the eye. I find the goggles very comfortable and do not get hot and sweaty on your eyes. 

The other advantage of using swim goggles is that with the medical gauze it blocks the light in the early morning allowing me to sleep longer without being woken. My room faces east and in the morning especially in summer, the rising sun was waking me up too early. By blocking out the light you increase the odds of sleeping longer and more deeply. In addition, you are saving money by not buying sleeping aids such as Melatonin and more expensive sleep masks. 

3. Nexcare Eye Patches 

The Nexcare Eye Patches work as effectively as the swimming goggles when you put medical gauze swabs underneath the patch. Using the gauze puts just a little pressure on the eye. However, these are more expensive as the patch will last only one night. With the eye patches only, the CPAP air may get under the eyelid depending on your pressure requirements. 

You may also consider using the eye patches should you only want to cover one eye and do not wish to have any inconvenience of having an additional item of the goggles around your head. They are also good should you want a backup to the goggles. 

In the post next month Part 2, CPAP Air out Eyes and Tear Ducts, I will continue with the other options that are available to you to stop air coming out the eyes. 

Using the other options together with adjusting the CPAP and Bilevel settings, from personal experience all patients will be able to continue to use their sleep apnea machine and have a great night’s sleep. 

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. 

More details are on the blog post: 

Use BiPAP to prevent Alzheimer's Dementia caused by REM sleep issues
Further details on 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 are on the following blog posts:

Air through Eye Tear Duct - Introduction 

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 (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


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