{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:51:49Z","timestamp":1791906709311,"version":"4.3.4"},"reference-count":11,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2014,3,17]],"date-time":"2014-03-17T00:00:00Z","timestamp":1395014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Otol Rhinol Laryngol"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Continuous positive airway pressure (CPAP) is the gold standard treatment for moderate to severe obstructive sleep apnoea (OSA). Eye-related side effects of CPAP are commonly attributed to a poorly sealed mask, allowing leaked air to blow over the eye.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Cases:<\/jats:title>\n                    <jats:p>We present 3 cases where attended polysomnography (A-PSG) demonstrated CPAP-associated retrograde air escape via the nasolacrimal system (CRANS) in the absence of any mask leaks. Symptoms included dry eye, epiphora, air escape from the medial canthus, and eyelid flutter. Symptoms were controlled with a variety of surgical and nonsurgical techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>CRANS represents a previously undescribed clinical entity. CRANS may be responsible for some CPAP-related eye side effects and possibly for rarer secondary eye complications, including conjunctivitis and corneal ulceration. CRANS should be suspected in any patient on CPAP complaining of eye symptoms. CRANS may be diagnosed through careful observation during A-PSG and confirmed by performing a \u201csaline bubble test.\u201d Management options include nonsurgical (mask alternatives, humidification, nasopharyngeal airway) and surgical techniques (nasal airway surgery, inferior turbinate out-fracture and adhesion, injection of bulking agent around Hasner\u2019s valve).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0003489414525924","type":"journal-article","created":{"date-parts":[[2014,3,18]],"date-time":"2014-03-18T20:18:35Z","timestamp":1395173915000},"page":"321-324","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["Retrograde Air Escape via the Nasolacrimal System"],"prefix":"10.1177","volume":"123","author":[{"given":"Narinder Pal","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital\/University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robbie James Eades","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Cowan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur Craig","family":"Davidson","sequence":"additional","affiliation":[{"name":"Lane Fox Sleep Disorders Unit, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Newton","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,3,17]]},"reference":[{"key":"bibr1-0003489414525924","first-page":"CD001106","author":"Giles T","year":"2006","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"bibr2-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.4.9802027"},{"key":"bibr3-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2432"},{"key":"bibr4-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1016\/j.optm.2006.12.015"},{"key":"bibr5-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1378\/chest.86.5.802a"},{"key":"bibr6-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-35267-1_3"},{"key":"bibr7-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1996.01100140431010"},{"key":"bibr8-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2003.007195"},{"key":"bibr9-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.4.1112"},{"key":"bibr10-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1007\/s004050000278"},{"key":"bibr11-0003489414525924","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31815a9eea"}],"container-title":["Annals of Otology, Rhinology &amp; Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0003489414525924","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0003489414525924","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0003489414525924","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:30:16Z","timestamp":1777375816000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0003489414525924"}},"subtitle":["A Previously Unrecognized Complication of Continuous Positive Airway Pressure in the Management of Obstructive Sleep Apnea"],"short-title":[],"issued":{"date-parts":[[2014,3,17]]},"references-count":11,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,5]]}},"alternative-id":["10.1177\/0003489414525924"],"URL":"https:\/\/doi.org\/10.1177\/0003489414525924","relation":{},"ISSN":["0003-4894","1943-572X"],"issn-type":[{"value":"0003-4894","type":"print"},{"value":"1943-572X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,3,17]]}}}