How does obstructive sleep apnea affect overall eye health?
Obstructive sleep apnea (OSA) has a serious impact on virtually every part of the human body, and the eyes are no exception.
It is associated with several ocular conditions affecting various structures, from the tear film to the optic nerve.
Impact on the Eyelids and Cornea
OSA is frequently linked to conditions of the anterior segment:
- Floppy Eyelid Syndrome : This is a condition where the eyelids become so loose that they can open in the night. This can often associated with the upper lashes eyelashes pointing downwards over the vision or the eyelids turning inside out.
- Keratoconus: This is when the cornea (that clear dome over the eye) becomes thin. Keratoconus is more common in patients with OSA than those without. Research indicates that in populations with keratoconus, a significant percentage either have OSA or are at high risk for developing it.
Impact on the Optic Nerve and Glaucoma
The low oxygen at night due to OSA (also called nocturnal hypoxia) and changes in blood flow caused by OSA can damage the structures of the optic nerve.
- Glaucoma: OSA is associated with primary open-angle glaucoma (POAG) and, even more strongly, with normal-tension glaucoma (NTG).
- NAION: There is an exceptionally high association between OSA and nonarteritic anterior ischemic optic neuropathy (NAION), with approximately 70% of NAION patients also having OSA.
- Intracranial Pressure (ICP) Issues: OSA is associated with papilledema (optic disc swelling) and idiopathic intracranial hypertension (IIH) due to raised intracranial pressure.
Impact on the Retina and Vasculature
OSA affects the retinal blood vessels during the nighttime apnea events.
- Diabetic Retinopathy (DR): In diabetic patients, OSA is linked to an increase in DR and is specifically associated with the progression to proliferative diabetic retinopathy (PDR).
- Retinal Vascular Occlusion (RVO): OSA is considered a risk factor for RVO events, which often show up as sudden, painless vision loss upon waking.
- Central Serous Retinopathy (CSR): Fluid leakage in the macula.
If you are concerned or curious if you may have sleep apnea, make sure to speak to your GP or primary care doctor and eye care provider.
