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How Sleep Apnea Affects The Eyes

Did you know that some eye conditions are associated with sleep apnea? According to the National Sleep Foundation, more than 18 million Americans have sleep apnea, and Health Canada reports similar prevalence. It’s a sleep disorder where people stop breathing — often multiple times per night — while sleeping.

If you have sleep apnea: it tends to take longer for your tears to be replenished, you’re more likely to have ocular irritation, you have a higher chance of developing floppy eyelids, and you’re at increased risk for glaucoma.

What Is Obstructive Sleep Apnea?

There are different types of sleep apnea. The most common one is obstructive sleep apnea (OSA). During OSA, your airway becomes partially blocked due to relaxed muscles in your nose and throat. This causes apnea (the absence of breathing) or hypopnea (abnormally shallow, slow breathing). It’s twice as common in men, and is more likely to affect people with obesity, hypertension, diabetes or heart disease.

What are the common symptoms of sleep apnea?

Sleep apnea occurs when the muscles in the back of your throat relax too much to allow normal breathing. These temporary breathing lapses cause lower-quality sleep and affect the body’s oxygen supply, which can lead to potentially serious health consequences.

While snoring is a common symptom, not everyone who snores has sleep apnea. Interrupted sleep can cause excessive daytime sleepiness, fatigue, irritability or depression, headaches in the morning, difficulty concentrating and thinking, and a sore throat.

Which Eye Conditions Are Associated With Sleep Apnea?

Glaucoma

Glaucoma occurs when increased pressure within the eye damages the optic nerve, which connects the eye to the brain, leading to vision loss and sometimes blindness. In some cases, it might be due to a drop in blood oxygen levels, which happens when you stop breathing. However, CPAP machines, one of the most common treatments for sleep apnea, can also cause glaucoma.

So, people with sleep apnea — even if it’s being treated — need to get their eyes checked on a regular basis for glaucoma.

Floppy Eyelid Syndrome

Floppy Eyelid Syndrome (FES) is an eye condition where a person has an unusually large and floppy upper eyelid. It can cause eye redness, irritation, discharge, or blurry vision — and over 90% of people with FES also have sleep apnea.

Non-Arteritic Anterior Ischemic Optic Neuropathy

Non-arteritic anterior ischemic optic neuropathy (NAION) is an eye condition that occurs when there is a loss of blood flow to the optic nerve. Patients typically complain of significant vision loss in one eye without any major pain. Approximately 70-80% of patients with NAION have been found to have OSA.

Retinal Vein Occlusion

Also referred to as an ‘eye stroke,’ retinal vein occlusion (RVO) is a blockage of the small veins that carry blood away from the retina. A recent study of 114 RVO patients found that sleep apnea was suspected in 74% of the patients that had previously been diagnosed with RVO.

Other Eye Health Issues Associated With Sleep Apnea

Some other ocular conditions that are more common in patients with sleep apnea include: papilledema, keratoconus, and central serous chorioretinopathy. Furthermore, in addition to glaucoma mentioned above, CPAP machines are associated with dry eye syndrome and bacterial conjunctivitis.

Talk To Your Doc

Get eye exams regularly to rule out eye disorders and prevent potential vision loss, especially if you have been diagnosed with sleep apnea. At Elite Dry Eye Spa in Tucson we encourage you to share your medical history with us so we can better diagnose and treat any eye conditions or ocular diseases you may have, and help you keep your eyes nice and healthy.

Our dry eye evaluation vs a routine eye exam

When you are experiencing chronic signs and symptoms of dry eye disease, there’s really a lot to it. In some practices, an eye doctor examines the health of the cornea and will use a dye test to see if the cornea is dry. With the advanced in eye care technology & diagnostics, dry eye disease testing has advanced tremendously, and our office is at the forefront of it.

Because dry eye disease is so complex & multifactorial, it can NOT be properly evaluated during a routine yearly eye exam for glasses or contact lenses, or if you’re going in for eye surgery.

Honestly, if you are going in for your routine eye care based on your yearly or your six-month appointments, most busy practices don’t allow for more time to do an additional dry eye evaluation.

You will pretty much stick to the script of what you came in for or have you come back for a separate dry eye exam.

When I perform a complete dry eye evaluation, I start with my speed questionnaire, and that’s just assessing what is bothering you and how bad your symptoms are bothering you.

Then, I also perform two non-invasive lab tests of your tears. What I’m looking for are markers of inflammation and increased tear osmolarity readings. Both of those are very indicative of whether you need a pharmaceutical prescription or not.

Our testing is still not done. The exam follows up with an evaluation of your eyes under a microscope. This helps me assess where I need to focus once I put you on the Oculus Keratograph.

The Oculus Keratograph is an amazing piece of technology that documents each eye with 21 images of what is specifically going on with your dry eye disease, such as aqueous deficiency, lipid layer health, lid function, presence of blepharitis, corneal inflammation, and most importantly the function of your meibomian glands – are they intact, have they atrophied, and are they putting out oil? Oil is the most important top layer of our tears and a common cause of dry eye disease.

The best thing about my workup is that patients can see what I see. I’m not just explaining to them what their tears are or are not doing, and it’s not based on a hunch or guesswork. I can actually turn my monitor around, and allow the patient to see what their eyes look like, what is and is not functioning, or what is contributing to their dry eye signs and symptoms.

It’s a beautiful thing. I’m a very visual person. I like visuals, so I use lots of them once a diagnosis is made, be it mild, moderate, or severe dry eye disease, and I give my patients the option to proceed or have treatments based on what we see and what can be fixed.

Our dry eye evaluation is far more thorough than a regular dry eye exam, and in some cases, our dry eye evaluation is more thorough than a typical eye care provider’s dry eye exam because we specialize solely in this area.

8 Tips to Relieve Winter Dry Eyes

Whether you live in a climate with cold winter weather or you are planning a ski trip up north, winter can be a challenge if you suffer from dry eyes. Dry, cool air, cold winds and even drier indoor heating can cause eye irritation, burning, itchiness and redness, and sometimes even excessively watery eyes as more tears are produced to compensate for the dryness. Many people have a chronic feeling that they have something in their eye and some even experience blurred vision. These symptoms can be debilitating!

Dry eyes is one of the most common complaints eye doctors get from patients during the winter season, especially in the cooler climates. That’s why we’d like to share some tips on how to relieve dry eye discomfort, and how to know when your condition is serious enough to come in for an evaluation.

Tips to Relieve Winter Dry Eyes:

Keep eyes moist using artificial tears or eye drops. You can apply these a few times each day when the eyes are feeling dry or irritated. If over-the-counter drops don’t help or if you have chronic dry eyes, speak to your eye doctor about finding the best drops for you. Since not all artificial tears are the same, knowing the cause of your dry eye will help your eye doctor determine which brand is best suited for your eyes.
Use a humidifier to counteract the drying effects of indoor heaters or generally dry air.
Point car vents or indoor heaters away from your face when the heat is on. Try to keep your distance from direct sources of heating, especially if they blow out the heat.
Drink a lot! Hydrating your body will also hydrate your eyes.
Protect your eyes outdoors with sunglasses or goggles – the bigger the better! Larger, even wrap-around glasses as well as a hat with a wide brim will keep the wind and other elements out of your eyes. If you wear goggles for winter sports, make sure they fit well and cover a large surface area.
Soothe dry eyes using a warm compress and never rub them! Rubbing your eyes will increase irritation and may lead to infection if the hands are not clean.
Give your eyes a digital break. People blink less during screen time which is why extensive computer use can lead to dry eyes. Follow the 20/20/20 rule by taking a break every 20 minutes to look 20 feet away for 20 seconds and make sure you blink!
For contact lens wearers: If you wear contact lenses, dry eyes can be particularly debilitating as the contact lenses can cause even further dryness and irritation. Contact lens rewetting drops can help your eyes feel better and may also allow you to see more clearly. Not all eyedrops are appropriate for use with contact lenses, so ask your optometrist which eyedrop is compatible with your contacts and cleaning solution. If rewetting drops don’t help, consider opting for glasses when your dry eyes are bad, and speak to your optometrist about which brands of contact lenses are better for dry eyes. Many people find dry eye improvement when they switch to daily single use contact lenses.

Chronic Dry Eyes or Dry Eye Syndrome

Dry eye syndrome is a chronic condition in which the eyes do not produce enough tear film, or do not produce the quality of tear film needed to properly keep the eyes moist. While winter weather can make this condition worse, it is often present all year round. If you find that the tips above do not alleviate your discomfort or symptoms, it may be time to see a optometrist to see if your condition requires more effective medical treatment.