Obstructive Sleep Apnea Linked With Ocular Dysfunctions

obstructive sleep apnea, CPAP machine, sleep
Researchers associate the condition with corneal, ocular surface, and meibomian gland changes.

According to the results of a study published in the Journal Français d’Ophtalmologie, patients with obstructive sleep apnea syndrome (OSAS) can develop eyelid margin abnormalities, experience loss of and morphological changes in the meibomian glands, and have reduced endothelial cell density.

In a cross-sectional study, researchers from the University of Health Sciences, Yuksek Ihtisas Training and Research Hospital in Bursa, Turkey, compared the characteristics of the cornea and anterior segment, dry eye symptoms, meibomian gland morphology, and non-invasive tear film break-up time in patients with OSAS and healthy volunteers. Patients with OSAS were recruited from the hospital’s neurology clinic.

The study included 47 patients with OSAS (23.4% women 76.6% men, mean age, 45.77±9.65 years) and 47 healthy volunteers (27.7% women 72.3% men; mean age, 44.26±8.54 years). The mean body mass index of the patient group was significantly higher than that of the control group (30.1±4.82 kg/m2 vs 26.23±4.2 kg/m2; P <.001).

Patients with OSAS presented more frequently with floppy lids (17% vs 0%; P =.006) and had a higher lid margin abnormality score (1.09±0.8 vs 0.21±0.51; P <.001) than healthy volunteers. No significant differences were observed between the OSAS and control groups for non-invasive tear film break-up time or corneal topographic measurements, with the exception of apical corneal thickness (556.96±42.4 µm vs 569±103 µm; P =.037). The mean endothelial cell density was significantly lower in the OSAS group than in the control group (2609±259.96 vs 2756±179 cells/mm2; P =.002). 

Patients with OSAS showed significantly higher meibomian gland loss in both the lower and upper eyelids (P <.001 for both) and more frequent dilatation (38.3% vs 8.5%; P <.001) and distortion (66% vs 42.6% P <.001) in the meibomian glands compared with the control group. 

Limitations of the study included the relatively small sample size and a lack of prior knowledge of the patients’ sleep problems.

“This is the first study in which all dry eye findings, meibomian gland examination, corneal endothelial morphology, and corneal topographic examinations were performed together in [patients with OSAS],” report the investigators. “[These] patients develop eyelid margin abnormalities, loss of meibomian glands, and morphological changes in the meibomian glands. A significant reduction in corneal endothelial [cell density] indicates that systemic hypoxia in OSAS has an effect on the cornea.”


Ulutas HG, Balıkcı Tufekci AB, Gunes A. Evaluation of corneal, ocular surface, and meibomian gland changes in obstructive sleep apnea syndrome. J Fr Ophtalmol. Published online December 24, 2021. doi:10.1016/j.jfo.2021.09.007