The causes of red eyes can often be a mystery. Patients have reported dry eye problems induced by CPAP machines. Obstructive sleep apnea disorder causes nighttime breathing to stop at short, repeated intervals. The resulting low blood oxygen saturation levels cause daytime drowsiness and fatigue. It is often accompanied by very loud snoring and the affected person may wake up “short of breath” several times a night. Sleep apnea can lead to serious health problems and mortality if it is not treated over time. Continuous positive airway pressure, or CPAP, is used as standard treatment. A CPAP keeps the upper airway open by providing a constant flow of air through a mask or “nasal pillows that are worn while sleeping. Low compliance with the CPAP machine is often reported due to various issues. Solving these problems is critical to your health “being and continued use of a CPAP machine.

Eye problems reported with CPAP therapy include dry eyes, red eyes, puffy eyes (skin around the eyes), and redness of the eyelids and face around the eyes. Any of these symptoms should be discussed with your doctor who prescribed CPAP therapy and, if necessary, you can ask your optometrist for further help.

You may be inclined to believe that the source of your dry eye, eye inflammation, pink eye, or puffy eye is caused by an allergy to the mask. Most of today’s masks are latex free and made from silicone polymers. The incidence of true silicone allergy is almost negligible. Eye symptoms can be due to several factors.

– A mask can be too tight putting pressure on your face

– A mask may be too loose, causing air to flow through your eye at night, causing dry eye and simulating dry eye syndrome. The main difference is that CPAP-induced dry eye will get worse upon waking and improve as the day progresses, while dry eye syndrome generally worsens as the day progresses.

– A worn or defective mask may leak.

– Worn nasal pillows may begin to blow air into the eyes.

– It is postulated that air pressure could induce dry eye by forcing air through the tear openings. Point plug occlusion by an ophthalmologist can be tried with temporary collagen point plugs to rule out this possibility.

-Patients with sleep apnea also have a higher frequency of floppy eyelid syndrome. Floppy eyelid syndrome is a loose upper eyelid that flips over (turns inside out) easily. Patients with untreated sleep apnea often sleep on their side on their stomach on a pillow in an unconscious effort to keep their airways open. Due to a loose eyelid, the eyelid lifts, exposing the lining of the conjunctival tissue. This constantly rubs against the pillowcase causing mechanical irritation and exposes the fabric to any allergens found in the pillowcase. Conjunctival tissue can become chronically inflamed with papillary conjunctivitis and red eyes on waking. Treating sleep apnea will help to resolve the problem, as tummy-down rolling will be reduced. There is no longer hypoxia (oxygen deprivation) and the mask itself provides behavioral changes in sleep posture as it protrudes from the face. Treatment of any remaining dry eye symptoms remains essential.

– Occasionally, a person will already have dry eyes or will sleep with their eyes partially open, which will make leaking masks more symptomatic. Treatment of primary dry eye syndrome is essential in this case and should be done in consultation with your ophthalmologist.

– Some people may be more sensitive to the pressure of the mask under the eyelids on a repetitive basis and could benefit by using masks in different ways in the following nights. The fit of a mask is so important that it may not be an option and your doctor may need to use prescription ointments (usually after removing the mask).

– Complementary treatment by your eye doctor may be necessary for dry eyes, artificial tears such as Thera Tears, some prescription eye drops.

– Your optometrist may also prescribe an eye treatment for mask-induced red-eye conjunctivitis with eye medications such as Patanol.

Discuss your problems with your doctor. Simple measurements may be all you need. Readjusting the mask straps, replacing a mask, or changing the mask type may completely resolve your eye symptoms. If you are unable to resolve your problems after your visit, the next step should be an eye exam with your optometrist.