Air shoots out eye thru nasolacrimal duct when using cpap

Hello. My name is Dave and I am brand new to this as I have just discovered cpaptalk.com this evening, so please be patient with a newbie I have severe obstructive sleep apnea and have for many years, and about 3 years ago went thru testing for this. In the testing process, the pressure they took me up to, which was 20, permanently blew out (for lack of a knowledge of better medical terminology) my left nasolacrimal duct, so that when I use a cpap machine anytime or even just hold my mouth and nose and pressurize, air will constantly squirt out of the corner of inner corner of my left eye. This made me so angry that I quit cpap treatment altogether. Well, it is 3 years later and I have calmed down and wish to do things right here and get on the machine, and my goal would be to stay on the machine until such time as I sufficiently lose enough weight that the doctor lets me off of it. Just FYI, I used a mask that covered both my mouth and nose because they could never get just a nasal mask or pillows to work due them not being able to get my mouth to shut when I slept no matter what they tried. I am writing this to see if anyone else has any experience with this problem and could offer any insight and/or possible solutions, and also to see if anyone has heard of a full face mask and if so would it potentially solve this problem. all help is appreciated. thanks, Dave

Dave, I am new to CPAP (one month). I am sure you will get more replies from the veterans.
A quick search of CPAP.com shows that there are two total face masks made by Phillips Responics.

https://www.cpap.com/productpage/respir ... dgear.html

I'm sorry to hear about the nasal duct 'blow-out' and I would be quite frustrated about this as well.

Jerry

Dave: it appears your issues are with your mask. Mask-shopping is normal. Go to your DME (Durable Medical Equipment - the place you get your "stuff"). They should have a large array of masks. There are about three (I say four) types of masks - and you need to find the one that is comfortable and doesn't leak:

- nasal masks - shoots air thru the nose - you can't be a mouth breather and you need to keep your mouth shut all night (my wife likes this one!). You can use a chin-strap, tape or other mechanisms to aid keeping your mouth shut.
- full face masks - you have this one. There are mutiple- styles and brands of this type.
- the type of mask that covers the mouth and provides pillows for the nose. The industry calls this a "full face" mask, but to me it is a different mask than the one I described above. The Liberty Mirage from Resmed is an example of this type
- the total face mask - that's what I use - see below.

Either way - the key to sucessful therapy is you "love-affair" with your mask. If the mask doesn't leak, and is comfortable to a point where you can sleep with it on, you will be sucessful with therapy. The DME will let you try on different masks and return it within 30 days if the mask you took home is not for you. Also, I don't know what insurance you have, but most will buy you a new mask every 3-6 months.

Happy Papin'

Sheriff

Hi Dave.

First of all, you will have to see an ENT and/or an opthalmologist to treat your nasolacrimal duct issue. This may be treated so that air will not penetrate from your oral/nasal cavity through your nasolacrimal duct and shoot out the inner corner of your left eye.

Second, try to see if your DME can provide you with an auto adjusting CPAP machine. The most popular around is the S9 Autoset and you can see that most members here are using that. This is important because the pressure requirements to contend with your obstructive apnea may vary from time to time, so it is possible that you may not need the 20 cmH20 setting that was prescribed by your therapist. Finding the lowest setting at all times is important given your condition with your nasolacrimal duct. The lower the setting, the less prone you will be to nasocrimal duct issues.

Third, it appears you will need to explore the fact that you may only use a total face mask. This mask puts equal pressure against your entire face, so the issue of air leaking through your nasolacrimal duct will be prevented somewhat. There are at least two models available at cpap.com. You can start with those.

Keep us posted, buddy.

Best regards,
Tsubs

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.

I hadn't heard of this condition before, but it made me wonder about those people who have a habit of holding their nose shut when sneezing. They could easily blow out the duct.

I agree that the total face mask will equalize the pressure on both ends of the duct and prevent your symptom from occurring.

I can understand how a slight anomaly in structure could result in an open pathway.
I have had a tear duct squirt while sneezing; but only once or twice in as many decades.
If Dave can wear a total face mask like one of the two that Respironics sells on cpapdotcom,
it could be a less invasive solution; and well worth trying before more aggressive means.
Above all, Dave, don't give up--there is a way.

@Jerry- thanks for the information and support Jerry, I really appreciate it.

@Sheriff- thanks, I am definitely not giving up till I find a mask that works, and I hope the full face is it.

@Tsubs- thanks, I have seen 3 ENTs now and they all have told me there is no corrective surgery for the blowout; it may fix itself in years to come or it may stay like this forever. And I just started back up with a new physician and will definitely explore the apap option and the full face option. I appreciate your reply and the support.

@maddoget196- thanks for the reply, keep following this and I will post my results and any other info I gather on this.

@DaveLP- I'll definitely be trying the full face mask and will post results here to let you know.

@Chunkyfrog- thanks for the reply and the support. and I am all up for the least invasive method. I won't give up; one way or another I will get the upper hand on this pain-in-the-rear thing called sleep apnea

David, as I understand the raising of the intraocular pressure is more dangerous than dry eyes. See this past post which relates to it:


Link:

viewtopic/t32188/Eye-Pressure-and-CPAP.html

*****************************************
The following is a copy of old post by Sundra:


There have been quite a few posts on this very subject lately. I'm not sure if there is any definitive proof that cpap therapy can increase intraocular pressure, but there is a definite strong link between OSA and glaucoma. I was recently diagnosed with glaucoma with damage to the left eye and I use drops twice a day in that eye now and will have to keep a close watch on pressure in both eyes since they were both high. The best thing to do is keep a close check on it and get treatment to reduce pressure (usually rx eyedrops) if necessary. Maybe in the future, we will see some studies as to whether cpap affects IOP in any way. Would be interesting if they would publish a study on that topic.

Sundra
*********************************************************

See more on it from a later date here :


Link:

http://www.ncbi.nlm.nih.gov/pubmed/18326715

Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea.

Excerpt:

CONCLUSIONS: Patients with OSA demonstrated significant 24-hour IOP fluctuations, with the highest values at night. CPAP therapy causes an additional IOP increase, especially at night. Regular screening of visual fields and the optic disc is warranted for all patients with OSA, especially those treated with CPAP.

Note that the issue is not with the mask but the air pressure from the nose enters the inner eyes and causes glaucoma.

SINCE IT"S NOTHING TO DO WITH A MASK YOU NEED TO CHECK ON IT WITH AN OPTHAMOLOGIST AND NOT A SLEEP DOC. ALL MASKS USE THE NOSE TO PUSH AIR INTO TO LUNGS.

Thanks Sundra, very good stuff to know and I will definitely keep all this in mind as I go thru this process and consult with my doctor.

David, be sure you're not confusing a "Total" face mask with a "Full" face mask.

"Full" covers nose and mouth.

"Total" covers nose, mouth, and eyes.

A "total" face mask would seem like it would help your duct problem, but check with your doctor.

Dave: if you look at the total face mask that I use, you need to decide if you can wear this contraption, get used to it and get any rest with it. I was having trouble with my full face mask because I couldn't get a good seal under my cheeks, I was getting terrible nose blisters on the bridge of my nose, the nasal pillows were leaking (I have a plugged nostril) and my nose sores weren't healing. I was at cpap.com in Houston, and when I saw the total face mask I knew that "this was my mask"! The folks at cpap.com are really nice and the lady allowed me to try it on. She also got me a pillow, hooked up a cpap machine, and allowed me to lay down on the floor, roll around and adjust the straps. The seal on a total mask is around your cheeks, your chin and above your eyes. This makes it easier to adjust for leaks and there are no sores. It is a cumbersome mask, but since I am also a mouth-breather, there are no issues. That being said, it probably should be a last-resort mask. If you can get used to a nasal mask or a full face mask, work with them. If they don't work, welcome to the full face crowd... my wife calls it my "gas-mask" but it works for me and I won't try any other mask.

Sheriff

David, your post is confusing and it seems to me that none of the above replies relate to your Nasolacrimal duct (a.k.a tear duct) being blown out. Since all CPAP masks work via the nose to supply air to your lungs, your problem has nothing to do with a kind of mask. I am taking a guess that you could NOT use a CPAP untill your blown duct is surgicaly repaird.

See here how these ducts work:

http://en.wikipedia.org/wiki/Nasolacrimal_duct

I am repeating the link to a report about the problem that you have:


http://www.ncbi.nlm.nih.gov/pubmed/18326715




A surgical probe takes about 10 minutes. A thin, blunt metal wire is gently passed through the tear duct to open any obstruction. Sterile saline is then irrigated through the duct into the nose to make sure that there is now an open path. There's very little discomfort after the probing.

The photo shows liquid flowing upward from the blocked nose thru the nasolacrimal duct and squirting from an exit near the ball of the eye.

avi123 wrote:David, your post is confusing and it seems to me that none of the above replies relate to your Nasolacrimal duct (a.k.a tear duct) being blown out. Since all CPAP masks work via the nose to supply air to your lungs, your problem has nothing to do with a kind of mask. I am taking a guess that you could NOT use a CPAP untill your blown duct is surgicaly repaird.

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?

Avi,
Archangle is correct. my thought was that a total face mask would equalize the pressure from the eye duct and thus stop air from blowing out thru there. 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. I was hoping thru this post to see if this thought of the total face mask (that would also cover the eyes) fixing my particular problem has been put into practice by anyone and if so what the results are.

thanks, Dave