Obstructive Sleep Apnoea (OSA)

A link between the eye and the rest of the body.

By Dr Leanne Cheung

“Do you believe in iridology?” is a question I am often asked.

Well, the eye actually can be the link to disease in the rest of the body. There are many eye conditions associated with illness affecting other parts of the body. Since the eye is so easily accessible to examine, often as ophthalmologists we may be the first to suspect these diagnoses.

One less obvious example is Obstructive Sleep Apnoea (OSA) – a respiratory disease where the airway is repeatedly blocked for short intervals during sleep, such that inadequate oxygen is breathed in. The patient may end up needing a special mask (CPAP) at night to ensure adequate oxygenation whilst asleep.

The following eye diseases are associated with this, and sometimes I will send a patient for assessment by a sleep clinic to diagnose OSA, based on the association between the two diseases and individual patient symptoms. In this way, some patients find out that their “innocent snoring” actually needs treatment.

Eye Conditions associated with Sleep Apnoea:

• Floppy Eyelid Syndrome (FES): In this condition the upper eyelids are extremely floppy with loose attachments and easily turn inside out such that the conjunctival lining of the eyelid is exposed during sleep. This causes symptoms of irritation and redness, with mucous discharge due to the conjunctivitis. Patients are often unaware of the underlying cause. Treatment involves lubrication with ointments and possibly surgical correction.

• Glaucoma: A progressive degeneration of the optic nerve causing peripheral vision loss often associated with high pressure within the eye. Glaucoma is painless, and the diagnosis is usually made during routine eye checks due to the appearance of the optic nerve and further testing. Treatment is with laser or eye drops and occasionally surgery for severe cases. Glaucoma is more prevalent amongst patients with OSA. Interestingly, a recent article published in the Journal of Glaucoma showed an increased risk of glaucoma amongst OSA patients who also had floppy eyelids, than OSA patients without floppy eyelids.

• Ischaemic Optic Neuropathy (NAION) causes sudden, painless vision loss due to reduced blood flow to the optic nerve. Other risk factors for this disease are hypertension and diabetes. Unfortunately there is no treatment for the neuropathy apart from treating the risk factors to try and prevent the same thing happening to the other eye. A recent article from the British Journal of Ophthalmology looked at 20 patients with NAION and found 85% also had sleep apnoea.

So, the eye might be reflecting other parts of the body after all……..