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Air regurgitation in patients on continuous positive airway pressure (CPAP) therapy following dacrocystorhinostomy with or without Lester Jones tube insertion.
  1. Paul Stephen Cannon1,*,
  2. Simon N Madge1,
  3. Dinesh Selva2
  1. 1 Royal Adelaide Hospital, Australia;
  2. 2 South Australian Institute of Ophthalmology, Australia
  1. Correspondence to: Paul Stephen Cannon, Discipline of Ophthalmology & Visual Sciences, University of Adelaide & South Australian Institute of Ophthalmology, Discipline of Ophthalmology & Visual Sciences, University of Adelaide & South Australian Institute of Ophthalmology, Adelaide, SA 5000, Australia; pscan05{at}yahoo.co.uk

Abstract

Aims/Purpose: 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 a LJT inserted and 2 patients had a DCR procedure, 1 was external and 1 was endonasal. All 4 patients had resolution of their epiphora. Three patients had superficial epithelial keratopathy requiring lubricant therapy. All patients attempted using ointment at 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 3 patients reduced the pressure of their CPAP therapy without any improvement. All 3 patients had persistence of air regurgitation at a mean follow-up of 18 months.

Conclusion: 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.

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