The Link between Obstructive Sleep Apnea and Dry Eye Disease: Pathophysiology and Current Updates

Area of Science:

• Ophthalmology
• Sleep Medicine
• Ocular Surface Disease

Background:

• Obstructive Sleep Apnea (OSA) and Dry Eye Disease (DED) are increasingly recognized as interrelated conditions.
• Intermittent hypoxia and oxidative stress in OSA disrupt tear film stability, leading to DED.
• Continuous Positive Airway Pressure (CPAP) therapy, while standard for OSA, can have detrimental effects on DED.

Purpose of the Study:

• To review the multifactorial etiology of OSA-related DED.
• To highlight the roles of inflammation, lipid metabolism dysfunction, and mechanical stress.
• To emphasize the need for interdisciplinary management of OSA patients with ocular surface disorders.

Main Methods:

• Literature review focusing on the relationship between OSA and DED.
• Analysis of the impact of OSA pathophysiology on ocular surface health.
• Examination of CPAP therapy's effects on DED.

Main Results:

• OSA-induced inflammation, hypoxia, and oxidative stress contribute to both aqueous-deficient and evaporative DED.
• CPAP therapy may exacerbate DED through airflow leakage or retrograde air movement.
• Mechanical factors like sleeping position and eye rubbing worsen meibomian gland dysfunction in OSA patients.

Conclusions:

• OSA-related DED has a multifactorial etiology involving systemic/ocular inflammation, lipid dysfunction, and mechanical stress.
• Interdisciplinary management combining sleep medicine and ophthalmology is crucial for optimizing patient outcomes.
• Future research should focus on targeted therapies and improved CPAP designs to mitigate OSA-induced ocular complications.