Air shoots out eye thru nasolacrimal duct when using cpap

[avi123]

avi, with a total face mask, the air pressure would be the same on the inside of his nose and the eyes where the nasolacrimal duct comes out. With the same pressure on both ends of the duct, why wouldn't this reduce his problems with air coming out of the duct through his eye socket?

Reply:

I don't know.

I thought that some details, about the type of mask used, would be given in the following report but they don't:


http://www.iovs.org/content/49/3/934.full


Can you find any reliable data if a TOTAL face CPAP mask would reduce the danger of the greater interocular and ocular perfusion pressures while CPAPing?

See:

http://www.healthcare.philips.com/pwc_h ... askOIS.pdf

Contraindications
This mask may not be suitable for use on patients with the following conditions: glaucoma, recent eye surgery or dry eyes, nocturnal vomiting, hiatal hernia, impaired cardiac sphincter function, excessive reflux, impaired cough reflex, or on patients unable to remove the mask by themselves.

[rested gal]

Dave, here are some old discussions you might find interesting about CPAP air leaking out the tear duct:

HELP!!! Air or Fluid under "skin" of eyeball???
topic started by FatiguedMe
viewtopic.php?p=362442#p362442
_____________________

Air Comming Out My Eye
topic started by Titrator
viewtopic.php?t=529

______________________

odd side effect: air inside under lower eyelid
topic started by lebowski8
viewtopic.php?p=390772#p390772

______________________

Air pressure felt in tear duct and around eye
topic started by dexter_go
viewtopic.php?p=353999#p353999

_____________________

leaking from eye?
topic started by sifr
cpaptalk.com/viewtopic.php?p=398037#p398037

_____________________

air coming out of my eye
topic started by Itzavalanche
viewtopic.php?p=448301#p448301

[lebowski8]

this reminded me of a similar complaint I had:
viewtopic.php?f=1&t=43956&st=0&sk=t&sd=a

i still have occasional problems with it. seems that sometimes moving my head helps it. but your thread let me know there's some diagnostic ENT work that can be done, and i'll print this thread an take it to the doctor on my next check up

[purple]

Avi,
. . . And as I said earlier, unfortunately there is no surgery that will correct the damage done to the duct, or at least that is what 3 ENTs have told me now.
thanks, Dave

This is good to know. I have am on disability and have felt sure that Medicare would not pay to fix the problem. Now I know I am not missing out.

I use a Fischer and Paykel Forma Mask which is a Full Face Mask. The pressure of this mask near the bridge of my nose seems sufficient to close off the gap. I get no air from the tear duct. As I have a small nose, and OK, a relatively fat face, I use some mole skin across the bridge of my nose.

This particular mask is also difficult for a man, (we men have receding foreheads, whereas women have a more attractive even or protruding forehead) and this mask is more designed for a woman. The head piece that is intended to touch my forehead and keep the mask slightly off the upper part of my forehead will not touch at all, which creates too much pressure on the bridge of my nose. I created a spacer out of paper towels to fill this area, which works OK for me. I may go over to padacheeks place and see if she has something that will do this spacing as well.

Actually, I see some Masks which look like they would fit me better, that are more new. As Medicare limits how often I can get a new mask, might be Christmas before I consider that.

Thank you guys for information on this issue. Have a good nights sleep.

[nurse]

Hello. I have not posted to boards before this but want to share a tidbit that may help someone else. I have a reconstructed lacrimal tear duct - this duct does not have a one-way valve as a normal duct does. Therefore air is easily blown up through the valve, out the duct and into my eye. One night with a mask that covered nose and mouth demonstrated this would never work. Besides the air blowing into my eye all night and the fluttering of my eyelid, my eye was so irritated and dryed out by morning it took a day to recover. I found the Oracle mouth only mask and am having great luck with it. Indeed it seems to perform as the manufacturer/creator of the mask intended - which is: when relaxed and/or asleep my oral pharynx is pushed up and blocks air from entering the nose. WALLAH - no more air through my duct into my eye. I am a happy camper to know that I CAN use the CPAP.

[browncamry]

Hi guys

first post here. thanks for having me.

I had this happen to me on a daily basis. I happened to have a tempur eye mask (for travelling, link below) with me, and it applies just enough pressure on the eye to prevent air leakage coming out through the CPAP device. The tempur sleep mask has these comfort grooves on it, which makes it different to others, and why it seems to work for this problem. And apart from that, it helps me sleep and prevents cpap mask leakages from hitting my eye.

http://au.tempur.com/accessories/travel ... gid=Travel

Happy sleeping!

Tam

[zmbee]

Hi Dave,

The Stanford Eye Clinic (I assume in conjunction with the Stanford Sleep Center) is studying this issue and I believe they are looking for CPAP users experiencing dry eye due to this very problem. If you want more information, let me know and I'll see if I can provide some contacts.

[Morning after]

Miserable night at sleep study. Figured it out this am that the air was coming out my nasolacrimal duct because of tear duct surgery years ago. The CPAP world should be asking every patient if they have had this surgery!! Really no one there knew why my duct was so sore and watering. Still not seeing properly today. I will have to decide what to do since I have severe apnea; with periods of not breathing at night. I assume a full face mask. Fortunate it came to me this am. My tear duct surgeon confirmed my suspicions.

[Sheffey]

Morning after

Thanks for updating this thread. Some old threads do have lasting value.

I never had the surgery on the duct, but I had an injury that caused the same problem you experienced for a short time. The injury healed and the problem went away.

I will have to decide what to do since I have severe apnea; with periods of not breathing at night. I assume a full face mask.

Just in case you don't know:

Nasal mask or nasal pillows - covers nose only.
Full face mask (FFM) - covers nose and mouth.
Total face mask - covers nose, mouth and eyes (https://www.cpap.com/productpage/respir ... dgear.html)

It would be appreciated if you update this thread as your case progresses. Of course, there are plenty of experienced users here who will be happy to help you with information and suggestions. They have been a great support group for me.

Best of luck.

[Pathos6]

Hi Dave,

I suffer from this same condition. I have a comfortable nasal mask; however, my right eye lacrimal duct also blows a stream of air into my eye as I sleep. This results in severe dry eye (feels like sandpaper when I first open my eyelid), which results in blurred vision. Strangely it only affects my right eye and not the left eye. I've tried using Systane eye ointment right at the corner of the eye (medial canthus) where the ducts open to act as a block with limited success. I usually squirt the Systane right on the ducts and then apply Genteal eye gel within the eyelid to reduce the drying effect. Other strategies have been published, including placement of a punctum plug by an Ophthalmologist which would definitely block any air leaking through the lacrimal duct. There was also a paper published that recommended using a full face mask (covering eyes, nose, and mouth) to counter the air regurgitation from the duct (see reference below).

As for the other issue of air blowing out the mouth as you sleep, I also deal with that too. I prefer the nasal mask; however, my mouth will open in the night and cause me to wake up. I've used a couple different chin straps (one from my Respiratory therapist and one from Amazon) to keep my mouth closed during sleep with somewhat limited success. Actually the absolute best chin strap I have found is to just use a regular Ace flexible bandage and wrap that around your chin and top of your head. It is by far more effective and more comfortable than most purchased chin straps.

Hope this information is helpful to you or someone else with this problem.

Reference:
Wrede JE, Parsons EC, et al. A novel treatment for nasolacrimal air regurgitation into the eye with CPAP: The total face mask. J Clin Sleep Med. 2018 Aug 15; 14(8): 1415-1417

[stocky21]

Hi All,

This is for all those new readers who are having this issue.

I have the same issue and I like to share my experience and fix.

I use the Phillips dreamstation and have tried every single mask. None would fix the issue, except the total fitlife mask which covers the EYES, nose and mouth. It equalised the pressure full stop!

Yes, it is a large mask and hence why I did not try it until it was the last resort. But I wish I did it sooner.

Despite some fitment issues and air leaks (which is annoying), overall I'm getting more sleeping hours and as a result I do feel less depressed from lack of sleep. I would definitely recommend a full mask (over the EYES, nose and eyes) to fix the tear duct issue.

Other comments:
- It fixed my tear duct issue. I can sleep throughout the majority of the night.
- Initially I had to enquire about this mask from several places. It appears not many providers stock it (due to the mask unpopularity?) or they are phasing this product out..... So be quick to get this mask or an alternative full face mask.
- I'm a back sleeper and don't turn much, so the mask is not a problem for me.
- I've got the XL size. Was told this most recommended for most adults. Make sure the provider offers a 30 day money-back trial.
- My mouth tend open, so I need to use a chin strap. And I ensure that I place the straps OVER the mask, not under. Yes, I look ridiculous and my provider actually ask me not to use a chin strap because she thinks I'm adding complexity to my CPAP setup. But it works for me..
- However after 2 weeks of using this mask, I'm still having some FITMENT issues (I don't think it caused due to the sizing). Sometimes air escapes from the top of the mask at the forehead, or my bottom of the mask at the chin. I just adjust it as they occur and I think I'm over tightening it (causing some discomfort). I've order this only and will wait till COVID quarantine is over to see my provider for coaching on how to put it on properly.

Good luck! Don't give up.

[AlexG]

I also have this problem, except it is my right eye. As a temporary solution I use a small piece of tape in the corner of my eye. My pressure was first set at 12, and now is a 15. I am currently using a Mirage Micro nasal mask. I have contacted my doctor, and was told some people have this condition. I was told about plugs for the ducts, and also about the masks that cover the entire face. The tape works for now, but I will follow this thread for others suggestions.

Hi all - I'm experiencing the issue on this thread. Lots of ideas to consider. Thank you everyone. Would be great to learn more about the idea presented above regarding using tape in the corner of the eye. Any further details? E.g., what tape to use and how to apply? Thank you!

[eldawg]

awe man this just started happening to me after about 8-10 years of CPAP with nasal pillows. using the F&P SleepSyle machine and F&P Eson 2 mask which has a diffuser with a pop-off filter on it. Going to try an experiment tonight and remove the filter to allow slightly more air flow exiting the mask. I suppose the machine is supposed to kick up to get to proper pressure but worth a try...good info here thanks all. my journey begins...