1. Retrograde Air Escape via the Nasolacrimal System: A Previously Unrecognized Complication of Continuous Positive Airway Pressure in the Management of Obstructive Sleep Apnea.
- Author
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Singh, Narinder Pal, Walker, Robbie James Eades, Cowan, Fiona, Davidson, Arthur Craig, and Roberts, David Newton
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SLEEP apnea syndrome treatment , *ACADEMIC medical centers , *ANATOMY , *EPIDEMIOLOGY , *CASE studies , *SLEEP apnea syndromes , *OPERATIVE surgery , *POLYSOMNOGRAPHY , *SYMPTOMS , *SOCIAL services case management , *CONTINUOUS positive airway pressure - Abstract
Background: Continuous positive airway pressure (CPAP) is the gold standard treatment for moderate to severe obstructive sleep apnoea (OSA). Eye-related side effects of CPAP are commonly attributed to a poorly sealed mask, allowing leaked air to blow over the eye. Cases: We present 3 cases where attended polysomnography (A-PSG) demonstrated CPAP-associated retrograde air escape via the nasolacrimal system (CRANS) in the absence of any mask leaks. Symptoms included dry eye, epiphora, air escape from the medial canthus, and eyelid flutter. Symptoms were controlled with a variety of surgical and nonsurgical techniques. Conclusions: CRANS represents a previously undescribed clinical entity. CRANS may be responsible for some CPAPrelated eye side effects and possibly for rarer secondary eye complications, including conjunctivitis and corneal ulceration. CRANS should be suspected in any patient on CPAP complaining of eye symptoms. CRANS may be diagnosed through careful observation during A-PSG and confirmed by performing a “saline bubble test.” Management options include nonsurgical (mask alternatives, humidification, nasopharyngeal airway) and surgical techniques (nasal airway surgery, inferior turbinate out-fracture and adhesion, injection of bulking agent around Hasner's valve). [ABSTRACT FROM AUTHOR]
- Published
- 2014
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