Aim To describe air regurgitation as a complication in patients on continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) following dacryocystorhinostomy (DCR) surgery with or without Lester–Jones tube (LJT) insertion.

Methods A retrospective review of all patients with air regurgitation on CPAP therapy who previously underwent a DCR/LJT procedure. Patient demographics, lacrimal surgical history, CPAP therapy and outcome were recorded.

Results Four male patients were identified. The mean age at presentation was 54 years. Two patients had an LJT inserted, and two patients had a DCR procedure, one was external, and one was endonasal. All four patients had resolution of their epiphora. Three patients had superficial epithelial keratopathy requiring lubricant therapy. All patients attempted using ointment to act as a barrier over the neo-ostium, which was unsuccessful. One patient had the LJT removed with resolution of the air regurgitation. Two patients changed their CPAP machines to variable, and three patients reduced the pressure of their CPAP therapy without any improvement. All three patients had persistence of air regurgitation at a mean follow-up of 18 months.

Conclusions Air regurgitation can occur following naso-lacrimal surgery in patients on CPAP therapy. Although this is an unusual complication, it should be discussed with the patient at the time of obtaining informed consent.