Objective:
To describe a case of choroidal detachment occurring after changes to continuous positive airway pressure (CPAP) therapy and discuss a possible relationship.
Approach:
- Case: A 76-year-old man with obstructive sleep apnea had used CPAP for 8 years. His pressure was increased and a new oronasal mask reduced leakage about 20 weeks before presentation.
- Evaluation and treatment: The patient developed left-eye visual symptoms and was found to have a massive choroidal effusion. He received topical dexamethasone and cyclopentolate; dorzolamide plus timolol was added when the detachment progressed and intraocular pressure rose.
- Follow-up: CPAP was continued. Ocular findings improved over 16 weeks with treatment, and visual acuity and eye anatomy continued to improve by week 18.
Key Findings:
- The choroidal detachment developed after CPAP pressure was increased and mask leakage was reduced.
- The detachment progressed to a kissing configuration, with visual acuity declining to hand movements and intraocular pressure rising to 27 mmHg.
- By week 16, the detachment had resolved anatomically; at week 18, visual acuity was 0.4 and intraocular pressure was 16 mmHg.
- The authors proposed that positive airway pressure might impair choroidal venous drainage, but noted that the mechanism and relationship to CPAP remain unproven.
Interpretation:
The authors suggested considering CPAP as a possible contributor in patients with otherwise unexplained choroidal detachment, while emphasizing that this single case cannot establish causation.
Limitations:
- CPAP continued while the ocular findings improved during corticosteroid, cycloplegic, and intraocular-pressure-lowering treatment.
- Thyroid-associated orbitopathy was not formally excluded because thyroid function testing was not performed.
- MRI, MRA, and digital subtraction angiography were not performed; these are more sensitive than CT for some low-flow vascular abnormalities.
- Available evidence did not directly link CPAP therapy with episcleral venous pressure.
Conclusion:
The report describes a temporal association between CPAP adjustments and choroidal detachment, but the cause remains uncertain.
Sources:
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