Mask-wearing may affect dry eye symptoms
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While most people did not report an increase in dry eye symptoms, a significant number said they experienced some ocular discomfort when wearing a face mask, according to results from a survey published in Contact Lens and Anterior Eye.
“During the COVID-19 pandemic, the widespread use of face masks was recommended as a key measure against the spread of SARS-CoV-2,” Laura Boccardo, of the University of Florence, and the Institute for Research and Study in Optics and Optometry, Italy, wrote. “This has led to some concerns, with masks being perceived as uncomfortable, or inconvenient: prolonged use of masks has been associated with complaints of a headache, difficulty in breathing, skin irritation, sweating and fogged glasses.”
In an observational, cross-sectional study, Boccardo used Google Forms to collect survey data from September to October 2020. Her purpose was to assess participants’ experience with mask-associated dry eye (MADE) during the COVID-19 pandemic. According to Boccardo, “this is the first study describing the prevalence of this condition.”
The survey involved 3,605 participants aged 11 to 88 years. The median age was 31 years, and 74.4% of participants were female. Boccardo included responses from people who had symptoms only while wearing their mask and whose symptoms worsened while wearing their mask.
She calculated odds ratios to evaluate the association between MADE and other factors such as age, sex and profession.
Of the 2,447 respondents who reported a history of dry eye symptoms, 18.3% said they experienced an increase in symptoms while mask-wearing. Moreover, 26.9% of those participants said their symptoms were “exacerbated when wearing a mask.”
Boccardo said a limitation to the study was that MADE is a temporary condition, suggesting that future research efforts should investigate the association between age and MADE.
“As face masks are necessary, along with social distancing and hygiene measures, to slow down the spread of COVID-19, it is important not to underestimate all symptoms that could discourage the population from using them,” Boccardo wrote.
To avoid or manage dry eye, Boccardo said experts should encourage people to “ensure that the mask is worn appropriately, apply lubricating drops, limit time in air-conditioned environments and take regular breaks from digital devices.”
Perspective
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Cecelia Koetting, OD, FAAO, DipABO
Anecdotally, many practicing ODs during COVID would tell you that we have noted an increase in patients’ dry eye symptoms and blepharitis/Demodex. The study by Boccardo and colleagues looked at the incidence of MADE. This study of 3,605 people, using a short online survey in August to September of 2020, found only approximately 18.3% of all patients experienced MADE.
Although there was a decent sample size, I don’t feel that the study was very strong. It had too many possible uncontrolled variables and no clinical confirmation of findings. It relied solely on patients’ subjective symptoms and recollection when answering a short survey asking patients very limited questions regarding their current and past dry eye disease symptoms.
Too many variables exist that were not accounted for including the patient’s amount of screen time and if they work from home or in an office/hospital where we know the environment can be drier. They were not asked how long they are typically wearing a mask during a day, which could obviously cause a large variance in responses about symptoms. It is also hard to compare a patient’s perceived baseline of dry eye symptoms prior to wearing masks, making their interpretation of their current symptoms while wearing a mask unreliable.
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