Ah . . . sleep medicine. Is this a great field or what? Caution — this particular blog will provide more questions than answers . . . I am counting on you to fill in some of the blanks.
I have been in this field almost 20 years now and I still am finding many different things that are interesting and important. It wasn’t until recently that I learned of FES (floppy eyelid syndrome) and the sleep connection. (See past blog on that topic.)
Jones Tubes
This week once again I learned about another “eyes and sleep” relational situation concerning CPAP and patients that have Jones tubes.
What are Jones tubes you ask? Jones tubes are small Pyrex tubes that are inserted in the eyelids (so yes VERY SMALL tubes) to remove tears in patients whose tear ducts are no longer functioning. They extend behind the inner corner of the eyelids to drain the tears into the nose.
In order to stay healthy, your eye releases tears each time you blink and this keeps your eye moist and healthy. But in certain instances, the teardrop duct that eliminates the tears into your nose fails to function properly.
Who knew that our tears flow into our nose! This is why your nose runs when you cry . . . excess fluid! But I digress . . . so why discuss this here in a sleep blog? Where is the connection you ask?
CPAP Problems With the Jones Tube
You see the introduction of CPAP therapy presents a tricky problem for the patients with these Jones tubes. CPAP pressure in the nose for patients using a nasal mask or pillows causes a leak through these tubes into the corner of the eyelids as it escapes out the Jones tube. This can also can cause eye pain as the air pushes through these open small Pyrex ports.
So what is the solution? Well that is where you blog detectives come in!
I found a few ideas online being a Google detective. I needed to read up on this as we had a patient with this situation recently. With our patient, our physicians spoke to eye doctors and eye surgeons and learned all about such wonderful things as “dacryocystorhinostomy,” which is a fancy word for an operation to create a new tear duct. Sometime that is not an option, however as the tear duct sometimes can’t be repaired. That is when Jones tubes can be utilized.
Full Face Mask and the Jones Tube
We did some research here at the sleep center and it appears that the standard recommendation is to use a full-face mask as this will allow the patient to diffuse the air through an open mouth under the mask. This seems to have been confirmed to work for these patients based on an online patient forum discussion. It also helps if, as in our case, the patient only needs a pressure of 7 cm CPAP pressure to control her sleep events. The patient did very well and experienced no issues with pain in her eyes using the full-face mask.
Other Jones Tube Solutions With CPAP
Another ophthalmology abstract I located online spoke of a simple solution that worked for their patient, which was taping a small bit of wet cotton over the opening of the Jones tube. Other than the patient mentioned in this abstract as doing well, I could not find other mentions of this as a solution.
So, this is what I have learned so far about Jones tubes and CPAP users. I told you there would be more questions than answers!
Was this something new to you too? Have you heard of this before? Do you know of other recommendations?
If you do, let me know! I’m all eyes! Oops! I mean all ears!
