The focus is usually on access to eye care, glasses and preventing avoidable blindness. What rarely comes up is sleep. Obstructive sleep apnoea, where breathing repeatedly pauses or becomes shallow during sleep, has been linked to a number of eye conditions. A review of 49 studies by researchers at the Centre for Eye Research Australia found links with glaucoma, floppy eyelid syndrome, retinal vein occlusion and a type of optic nerve stroke¹. A link doesn't prove that sleep apnoea causes these conditions, and people with sleep apnoea often share risk factors such as obesity, high blood pressure and diabetes¹. But the pattern is consistent enough that eye specialists are encouraged to consider sleep apnoea, and sleep clinics to check for eye problems¹.
Glaucoma & sleep apnoea
Glaucoma slowly damages the optic nerve, which carries images from the eye to the brain. The vision it takes can't be restored, and early on there are usually no symptoms. Glaucoma Australia estimates that more than 300,000 Australians have glaucoma and about half don't know it². It recommends that everyone aged 50 or over has an eye check with an optometrist every two years².
Sleep apnoea may play a part. When researchers pooled 21 studies, people with sleep apnoea had about 1.5 times the odds of having glaucoma¹. The evidence isn't settled, though. Australian researchers note that better-designed studies that account for other health conditions have been less consistent³, while a larger 2023 review found up to 40% higher odds even after adjusting for those factors⁴. One theory is that repeated drops in oxygen and blood flow overnight put stress on the optic nerve³.
Floppy eyelid syndrome & sleep apnoea
In floppy eyelid syndrome, the upper eyelids are unusually soft and rubbery and can flip inside out, often during sleep. This exposes the surface of the eye, which can cause irritation and, in some cases, damage to the cornea³. It is one of the best-documented eye conditions linked with sleep apnoea³, and people with sleep apnoea were more than three and a half times as likely to have it¹.
Treating sleep apnoea might help. In one small study without a comparison group, floppy eyelid syndrome reversed in about half of people after six months of CPAP, although another study found no difference in eyelid looseness between people who used CPAP and those who didn't³. If you've been diagnosed with floppy eyelid syndrome, ask your eye specialist whether a sleep study is worthwhile.
A stroke of the optic nerve (NAION)
Non-arteritic anterior ischaemic optic neuropathy, or NAION, happens when blood flow to the optic nerve suddenly drops. It causes sudden, painless vision loss, usually in one eye, and is often noticed on waking¹. It is rare, affecting roughly 2 to 10 in every 100,000 people over 50 each year³. However, its link with sleep apnoea is one of the strongest found: people with sleep apnoea were around four times as likely to have it¹.
In a small study of people who had already lost vision in one eye, those who used CPAP poorly were more likely to lose vision in the second eye³. For this reason, researchers suggest that anyone with NAION should be checked for sleep apnoea³.
Other eye conditions & sleep apnoea
Retinal vein occlusion, a blockage in one of the veins draining blood from the retina, was around two and a half times as likely in people with sleep apnoea¹. For people with diabetes, sleep apnoea has been linked with diabetic macular oedema, swelling at the centre of the retina, more consistently than with other diabetic eye changes³. In a small study of people having injections for age-related macular degeneration, those with untreated sleep apnoea needed about twice as many injections as those using CPAP, and had poorer vision at the end³. These findings are early, and research on age-related macular degeneration itself is still giving mixed results¹˒³.
Why might sleep apnoea affect the eyes?
Researchers think the repeated drops in oxygen, overactivity of the body's stress response and inflammation caused by sleep apnoea can harm the delicate blood supply to the eye¹. The retina has one of the highest oxygen demands in the body, so it may be especially vulnerable to low-oxygen episodes during the night¹.
Can treating sleep apnoea protect your eyes?
Possibly, but the research is still early. Most studies so far have been small and had no comparison group, and good-quality trials are lacking³. Because vision lost to glaucoma can't be restored², the aim is to protect the sight you have.
Two cautions apply to people using CPAP. First, CPAP can raise eye pressure, so people with glaucoma or at high risk of it should tell their eye specialist and may need closer monitoring³. Second, a mask that leaks can blow air across the eyes. In one study, about one in five CPAP users had previously had conjunctivitis from a leaking mask, so a well-fitted mask matters³.
If you already have low vision or blindness
People with vision impairment may be more likely to have sleep problems, including sleep apnoea⁵. Untreated sleep apnoea leaves people less alert, with slower reactions and poorer concentration⁶. For anyone who relies on memory, hearing and careful attention to get around safely, being alert matters. Treatment may also help protect remaining sight in some eye conditions, as described above³.
CPAP is the first-line treatment for sleep apnoea⁷. It uses a small, quiet pump and a mask to hold the airway open, and is very good at controlling symptoms and long-term effects⁶. Setting it up involves a mask, hose and often a water chamber and screen, so ask your sleep clinic for hands-on set-up and training, and make sure the mask is fitted to avoid air leaking towards your eyes³.
A mandibular advancement splint is a custom-made device, like a double mouthguard, that holds the jaw slightly forward overnight⁶. The Australasian Sleep Association notes that these splints are less obtrusive and more portable than CPAP, make no noise and need no power source⁷. With no mask or airflow, there are no leaks near the eyes to worry about. The Sleep Health Foundation says splints are particularly useful for snoring and milder forms of sleep apnoea⁶, and the Australasian Sleep Association also supports them for moderate to severe sleep apnoea when CPAP hasn't worked or can't be tolerated⁷.
Splints are held in place by the teeth, so a dental examination by a trained dentist is needed first, and side effects such as tooth soreness and changes to the bite are relatively common⁷. Dentists work alongside your doctor, as diagnosis is a medical responsibility⁷.
What to do next
If you have glaucoma, floppy eyelid syndrome, a retinal vein occlusion, an optic nerve problem or diabetes-related eye disease, and you also snore, have breathing pauses noticed by a partner, or wake unrefreshed, talk to your GP about a sleep study. Your GP can refer you⁶. Tell your eye specialist about any sleep apnoea diagnosis and CPAP use.
At SleepWise Clinic, we regularly see patients whose sleep apnoea has been flagged by specialists in other fields, including ophthalmologists who have made the connection in their clinical practice. If your eye specialist has raised the possibility of sleep apnoea, or if you have any combination of the symptoms described in this article, we are here to help.
Protect your eyes by protecting your sleep. Call SleepWise Clinic on 1300 101 505 to find out more about how long the sleep apnoea mouth guards take the fabricate, treatment prices for oral appliance therapy and what our fee includes, or book a call with a Treatment Coordinator to get you on your way.
ReferencesBulloch G, Seth I, Zhu Z, et al. Ocular manifestations of obstructive sleep apnea: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2024;262(1):19-32. doi:10.1007/s00417-023-06103-3.Glaucoma Australia. Treat your eyes. Book a test. https://glaucoma.org.au/treat-your-eyes-book-a-test; and Risk factors for glaucoma. https://glaucoma.org.au/what-is-glaucoma/risk-factors-for-glaucomaLee SSY, Nilagiri VK, Mackey DA. Sleep and eye disease: a review. Clin Exp Ophthalmol. 2022. doi:10.1111/ceo.14071.Cheong AJY, Wang SKX, Woon CY, et al. Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis. Eye (Lond). 2023. doi:10.1038/s41433-023-02471-6.Sleep improvement strategies for people with vision impairment: a scoping review. BMJ Open. doi:10.1136/bmjopen-2025-113100.Sleep Health Foundation. Obstructive sleep apnoea (OSA) [fact sheet]. https://www.sleephealthfoundation.org.au/sleep-disorders/obstructive-sleep-apnoeaAustralasian Sleep Association. The use of oral appliances in the treatment of snoring and obstructive sleep apnoea: a position paper. https://www.sleep.org.au/common/Uploaded%20files/Public%20Files/ASA%20Membership/Guidelines/OA%20Position%20paper.pdf
