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.
