Air regurgitation through the nasolacrimal duct in a patient on bi-level positive airway pressure therapy

Positive airway pressure therapy is usually a well tolerated mode of treatment used for managing patients with various diseases where either oxygenation or ventilation is compromised. Air regurgitation through the naso lacrimal duct (NLD) is a rare complication of positive airway pressure therapy. There are multiple valves in the nasolacrimal duct to prevent the retrograde airflow from the nasal cavity to the lacrimal sac, under normal physiological conditions. Failure of this multi level valve system will lead to the retrograde air flow from the nasal cavity to reach the lacrimal puncta via the nasolacrimal duct. Valve insufficiency by birth or due to a prior procedure done at this region could be the underlying cause for this complication. In this case report, we discuss about the appearance of air regurgitation in a patient with chronic obstructive pulmonary disease on bi-level positive airway pressure (BiPAP) therapy and we also discuss on the causes for this complication and the various treatment modalities to manage this condition.