Unilateral periorbital swelling with nasal CPAP therapy

A 53-year-old white female was diagnosed with obstructive sleep apnea by polysomnogram. Her OSA was initially treated with nasal CPAP with good resolution of her symptoms. Several months after initiating her CPAP therapy she developed unilateral periorbital swelling. Swelling improved off CPAP therapy, but with recurrence of her daytime sleepiness. An extensive work-up was carried out including evaluation by both ophthalmology and ENT. Neither found any reason for the development of the periorbital swelling. Further history obtained from the patient prompted additional testing. A CT scan of the orbits and sinuses with reconstructed view demonstrated a likely source of her periorbital swelling, a fracture in the superior aspect of the right orbit with sinus communication. Currently off nasal CPAP she has no further episodes of swelling, but has had return of her sleepiness symptoms. Alternative options for treatment of her OSA are being sought.