The Link Between Sleep Apnea and Eye Health

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Robert Miller

Robert has worked in the sleep and home respiratory healthcare space for over 29 years and is a Registered Polysomnographic Technologist. Robert has been married for 33 years to his wife, Laurie, has 6 children and 5 grandchildren. Robert leads sleep initiatives and strategies that improve the patient experience and promote better health outcomes so that our patients can achieve their best night's sleep—every night.

Research Demonstrates a Connection to 7 Ocular Disorders

Many people know that untreated sleep apnea can lead to such serious health consequences as diabetes, heart disease, and stroke.

But did you know that sleep apnea is also associated with a range of eye disorders?

It’s important to understand these disorders and their symptoms. Because an early diagnosis can prevent and even restore vision loss.

Causes of Eye Disorders

Changes in Oxygen Levels Affect Your Eyes

Sleep apnea causes people to stop and start breathing throughout the night. When they stop breathing, their oxygen levels drop (a condition called hypoxia). When they resume, their levels jump. The constantly fluctuating oxygen levels affect eye pressure and can lead to inflammation and ocular problems. 

Decreased oxygen levels also reduce blood flow to the eyes and can affect tear production. And sleep apnea causes some people to sleep with their eyes partially open, further increasing the risk of tear evaporation and dry eyes.

CPAP Can Cause Eye Irritation

Even the most effective form of treatment for sleep apnea – CPAP (continuous positive airway pressure) – can be associated with eye disorders. CPAP involves wearing a mask connected to a machine that delivers a constant flow of pressurized air to keep your airways open and ensure normal breathing and better sleep. 

But a common side effect of CPAP is eye irritation, often due to mask leaks that blow pressurized air directly into your eyes. This problem can be corrected by ensuring your mask fits properly and secures firmly to your face.

For more information: 6 Reasons Why Your CPAP Mask May be Leaking and How to Fix It.

7 Eye Problems Associated With Sleep Apnea

1. Floppy Eyelid Syndrome

Floppy eyelid syndrome is a condition where the upper eyelid of one or both eyes loses elasticity, becomes rubbery, and is easily everted (turned inside out). Doctors regard it as a major indicator of sleep apnea. To confirm the diagnosis, a sleep study (called a polysomnography) is often prescribed.

Symptoms of floppy eyelid syndrome include chronic irritation, eye dryness, redness, discharge, and infection. If floppy eyelid syndrome isn’t treated, it can lead to vision loss.

Treatment includes ointments, weight loss, and, in severe cases, surgical tightening of the eyelid.

2. Dry Eye Syndrome

This common eye condition affects more than 3 million Americans each year. It occurs when your eyes don’t receive adequate moisture. 

The risk of acquiring dry eye increases with age and often affects post-menopausal women.

Dry eye syndrome causes eye irritation, inflammation, and sensitivity to light. Eye drops or ointments and a proper-fitting CPAP mask help resolve dry eye.

3. Papilledema

Papilledema refers to swelling of one or both of your optic discs, which are located where the optic nerve enters the back of your eye and connects to your brain. 

Papilledema can be caused by increased spinal fluid pressure around the brain (called idiopathic intracranial hypertension or IIH). Clinicians believe this may be due to higher body carbon dioxide levels because of interrupted breathing from sleep apnea.

Symptoms include headaches, double vision (diplopia), and nausea.

Papilledema can lead to blindness and must be treated promptly. Treatments include CPAP and the medication acetazolamide.

4. Central Serous Retinopathy (CSR)

CSR happens when fluid accumulates under the retina, leading to retinal detachment and distorted vision. It usually affects just one eye but can affect both. Symptoms include blurry central vision, blind spots, and seeing colors incorrectly.

Numerous studies demonstrate that CSR is more common in people with sleep apnea than among the general public. Research also shows CPAP treatment can rapidly improve CSR symptoms.

5. Glaucoma

Glaucoma causes the loss of peripheral vision and blindness. More than 200,000 cases are reported in the US each year. 

Research reveals that glaucoma is more prevalent in people with sleep apnea than in the general population. 

People with glaucoma have elevated eye pressure, which damages the optic nerve. As with other eye disorders, hypoxia caused by sleep apnea may be the culprit.

Treatment for glaucoma includes medications, eye drops, surgery, and CPAP.

6. Nonarteritic Anterior Ischemic Optic Neuropathy (NAION)

Nearly 80% of people with NAION—sometimes called “eye stroke”—have sleep apnea. It occurs when there is a loss of blood flow (ischemia) to the optic nerve.

NAION typically causes sudden vision loss in one eye with no pain. In many cases, people notice significant vision loss when they wake in the morning. 

How sleep apnea causes NAION isn’t completely understood, but it’s thought that it may be linked to hypoxia and fluctuating eye pressure.

Although sleep apnea treatment can’t reverse vision loss from NAION, it may help prevent vision loss in the other eye.

7. Retinal Vein Occlusion (RVO)

Like NAION, RVO can cause vision loss. In RVO, there is a partial or total blockage in the small veins that carry blood away from your retina. This causes swelling and elevated pressure in your eye, resulting in blindness.

RVO affects over 16 million people; 37-77% of people with RVO also have sleep apnea.

Although there isn’t currently a method to unblock the vein, treatments ranging from injections to surgery are available to manage complications from RVO and protect your vision. 

See Your Doctor About Your Eye Health

If you have sleep apnea and notice any changes in your vision, don’t hesitate to contact your doctor. An eye disorder must be promptly diagnosed so your doctor can prescribe the most effective therapy available. 

Keeping an eye on eye disorders may prevent any further loss of vision. It even may improve your vision.

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References
1. Waller EA, Bendel RE, Kaplan J. Sleep disorders and the eye. Mayo Clin Proc. 2008 Nov;83(11):1251-61. 
2. Bence, S. (2022, March 17). Eye Conditions Linked to Sleep Apnea. Verywell Health. https://www.verywellhealth.com/sleep-apnea-and-eyes-link-conditions-treatment-5216606.
3. Stuart, A. (2013, February). Obstructive Sleep Apnea and the Eye: The Ophthalmologist’s Role. American Academy of Ophthalmology. https://www.aao.org/eyenet/article/obstructive-sleep-apnea-eye-ophthalmologist-s-role.
4. Ames, H. (2023, April 24). Is there a link between sleep apnea and dry eyes?
Medical News Today. https://www.medicalnewstoday.com/articles/sleep-apnea-dry-eyes#contacting-a-doctor.
5. (2015, October 9). How sleep apnea affects the eye. Optometry Times. https://www.optometrytimes.com/view/how-sleep-apnea-affects-eye.

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About the AuthorRobert Miller

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