The eye and sleep apnea

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Several eye disorders have been found in association with obstructive sleep apnea (OSA). This paper reviews the current state of knowledge of eye disorders associated with OSA.

OSA is associated with a number of eye disorders including floppy eyelid syndrome (FES), optic neuropathy, glaucoma, non-arteritic anterior ischemic optic neuropathy and papilledema secondary to raised intracranial pressure. FES patients have a very high incidence of OSA and a causal relationship may exist, but amongst patients with OSA, FES is uncommon but commoner than in the general population. Treatment of OSA may help floppy eyelid syndrome, halt progression of associated glaucoma or optic neuropathy, and reduce intracranial pressure in patients with associated papilledema.

Sleep apnea patients should be asked about ocular symptoms and appropriately examined or referred for assessment as some of the associated eye disorders may permanently impair vision. Ophthalmologists should be aware of the association of sleep apnea with these eye disorders and consider referral to a sleep physician for investigation and possible treatment.

Keywords: Obstructive sleep apnea; Floppy eyelid syndrome; Blindness; Eye diseases; Glaucoma; Non-arteritic anterior ischemic optic neuropathy; Papilledema; Idiopathic intracranial hypertension

Glossary of terms

Keratoconus
a corneal ectasia characterized by thinning, outward bowing and distortion of the corneal surface.

Non-arteritic anterior ischemic optic neuropathy
a condition of sudden onset characterized by unilateral visual loss, often with an altitudinal visual field defect, where the optic nerve head is swollen and pale and has suffered an ischemic event (the arteritic form of the condition occurs in giant cell (temporal) arteritis).

Normal-tension glaucoma
a form of glaucoma or optic neuropathy usually indistinguishable from chronic open angle glaucoma in which the main risk factor is raised intra-ocular pressure.

Papillary conjunctivitis
a clinicopathological term describing a thickened, velvety reddened surface of the conjunctiva lining the tarsal plates.

Punctate keratopathy
multiple superficial microscopic corneal epithelial ulcers, best seen under magnification using fluorescein staining.

Alan A. McNab
Orbital Plastic and Lacrimal Clinic, Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Vic., Australia

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