CPAP complications after dacryocystorhinostomy: a narrative review.

Study objectives: Patients with obstructive sleep apnea (OSA) often require the use of a continuous positive airway pressure (CPAP) machine. However, some patients experience issues using CPAP after receiving a dacryocystorhinostomy (DCR) for epiphora. This review aims to assess these complications and the potential interventions.

Methods: A systematic literature search was conducted in March 2023 with the PubMed, EMBASE, Web of Science, and Scopus databases. Since most of the studies were case reports and lacked quantitative results, a narrative review was done.

Results: Fourteen studies were included for review, representing 49 patients. During nightly CPAP use, 77.6% (38/49) of patients experienced air regurgitation onto the ocular surface via the tear drainage passage constructed by DCR. The interventions attempted could be categorized into (a) CPAP changes or (b) ophthalmic management. CPAP changes included changing the CPAP mask (successful in 5/6 patients), modifying the pressure or incorporating heated humidifier tubing (2/8 successes), changing the ventilation mode (1/3 successes), and switching to a CPAP alternative (1/2 successes). Ophthalmic management included eye plugs (3/3 successes), eye lubricants (2/6 successes), an eye patch (1/2 successes), and removal of the Lester Jones tube placed during DCR (1/1 successes). After trying these interventions, 36.7% (18/49) of patients continued to experience symptoms and opted to discontinue CPAP therapy.

Conclusions: CPAP related issues after DCR are common and can be difficult to treat. There are a variety of techniques to improve CPAP use and adherence after DCR.