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. 2021 Apr;75(2):144-148.
doi: 10.5455/medarh.2021.75.144-148.

Mask-Associated Dry Eye During COVID-19 Pandemic-How Face Masks Contribute to Dry Eye Disease Symptoms

Iva Krolo  1 , Matija Blazeka  1 , Ivan Merdzo  1   2 , Izabela Vrtar  1 , Ivan Sabol  3 , Ivanka Petric-Vickovic  1
Affiliations

Mask-Associated Dry Eye During COVID-19 Pandemic-How Face Masks Contribute to Dry Eye Disease Symptoms

Iva Krolo et al. Med Arch. 2021 Apr.

Abstract

Background: In the year 2020 we observe the world adapting to "new normal" due to the COVID-19 pandemic, ways of which include physical distancing, hand hygiene, and wearing a face mask. There is no conclusive evidence about ocular manifestations of the new coronavirus infection, but cases of conjunctivitis, keratitis, and episcleritis have been reported in infected individuals.

Objective: Determining if wearing a face mask during COVID-19 pandemic causes a new onset or deterioration of previously existing dry eye disease (DED).

Methods: A prospective cohort study included 203 participants, all using surgical facemasks daily due to new regulations during COVID-19 pandemic. Participants completed a survey, containing modified Ocular Surface Disease Index (OSDI) questionnaire. They were divided into groups according to: sex, age, duration of face mask-wear, and existence of prior DED history.

Results: Our results indicate that women have a statistically higher OSDI score compared to men (14.4 (IQR = 2.4 - 41.7) vs. 5.0 (IQR = 0.0 - 24.4); P = .004). Age did not significantly affect OSDI median values. Group that used masks from 3 to 6 hours/day demonstrated significantly higher OSDI scores compared to <3 hour/day group (15.3 (IQR = 8.3 - 47.7) vs. 8.3 (IQR = 0.0 - 35.1); P = .001). OSDI score was significantly greater in participants with prior DED history compared to those without it (36.1 (IQR = 14.1 - 61.6) vs. 4.2 (IQR = 2.3 - 8.3); P <.001). Participants with prior DED exhibited greater worsening of their disturbances during mask wearing period compared to the ones without previous DED (54.8% vs. 17.7%, Chi-Square 28.3 DF1; P <.001), regardless of daily mask wear duration.

Conclusion: Our study confirmed the existence of mask-associated dry eye (MADE), most profoundly in females, subjects with a history of prior DED, and if wearing a face mask lasts longer than 3 hours per day. Ophthalmologists should advise their patients of the potential ocular surface health risks related to inadequately fitted facemasks.

Keywords: COVID-19; Coronavirus; Dry eye; Face mask; MADE; Ocular surface.

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Conflict of interest statement

The authors of this paper certify that they have no conflict of interest to declare, ie they have no affiliations with or involvement in any organization or entity with any financial interest (eg honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, research support, stock ownership, other equity interest, or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Figure 1.
Figure 1.. OSDI score differences according to sex. Females had significantly higher OSDI score than male group. OSDI – Ocular Surface Disease Index, F – female, M – male.
Figure 2.
Figure 2.. OSDI score differences according to age. There was no significant difference of OSDI median values. OSDI – Ocular Surface Disease Index.
Figure 3.
Figure 3.. OSDI score differences due to daily face mask-wearing duration. Significantly higher OSDI score was noted in the group wearing masks for 3-6 hours/day, compared to 0-3 hour/day group. OSDI – Ocular Surface Disease Index.
Figure 4.
Figure 4.. OSDI score according to previous DED history. Prior DED group had significantly higher OSDI score. OSDI – Ocular Surface Disease Index, DED- – No previous history of dry eye disease, DED+- Existence of previous dry eye disease.
Figure 5.
Figure 5.. Worsening of the dry eye symptoms during mask-wearing period was significantly more common in participants who previously exhibited DED. DED- – No previous history of dry eye disease, DED+- Existence of previous dry eye disease.
Figure 6.
Figure 6.. Worsening of the DED symptoms during mask-wear was noted in subjects with prior DED history, regardless of face mask-wearing duration.
See this image and copyright information in PMC

References

    1. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470–473. - PMC - PubMed
    1. Bhattacharyya J, Tech M, Prajapat M, Shekhar N, Microbiology P, Avti S, et al. The Lancet Ocular Manifestations and Tear or Conjunctival Swaqb PCR Positivity for 2019-nCoV in Patients With COVID-19: A Systematic Review and Meta-Analysis. 2020
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. - PMC - PubMed
    1. Méndez Mangana C, Barraquer Kargacin A, Barraquer RI. Episcleritis as an ocular manifestation in a patient with COVID-19. Acta Ophthalmol. 2020 - PMC - PubMed
    1. Zhang X, Chen X, Chen L, Deng C, Zou X, Liu W, et al. The evidence of SARS-CoV-2 infection on ocular surface. Ocul Surf. 2020;18(3):360–362. - PMC - PubMed

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