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Observational Study
. 2025 Jul 29;29(4):254.
doi: 10.1007/s11325-025-03405-0.

The effect of mask usage on dry eye symptoms and meibomian gland function in OSAS patients: an observational study

Shu-Yi Wei  1 , Zhen Wu  2 , Yao Xu  3 , Dan Li  4 , Yimin Xia  5
Affiliations
Observational Study

The effect of mask usage on dry eye symptoms and meibomian gland function in OSAS patients: an observational study

Shu-Yi Wei et al. Sleep Breath. .

Abstract

Objective: To analyze the effect of mask usage on dry eye symptoms and meibomian gland function in patients with obstructive sleep apnea syndrome (OSAS).

Methods: OSAS patients who visited our hospital from January 2022 to December 2023 were selected as research subjects. All patients were treated with continuous positive airway pressure (CPAP) therapy. The polysomnography (PSG) results before and after treatment were analyzed, including the apnea-hypopnea index (AHI) and peripheral oxygen saturation (SpO2). Dry eye conditions and ocular surface analyzer results of patients before and after treatment were evaluated. Pearson correlation was used to assess the relationship between dry eye conditions and ocular surface analyzer results in OSAS patients, and the correlations between PSG results and dry eye conditions as well as ocular surface analyzer results were also analyzed.

Results: AHI levels in 31 OSAS patients were significantly decreased after treatment, while SpO2 levels significantly increased, with a statistically significant difference (P<0.05). After treatment, the tear breakup time (BUT), palpebral (PL) scores, and Ocular Surface Disease Index (OSDI) scores of patients were significantly higher than those before treatment (P<0.05). Additionally, after treatment, the tear meniscus height of OSAS patients was significantly lower than that before treatment, and the lipid layer thickness and eye redness index were significantly higher than those before treatment, with a statistically significant difference (P<0.05). The results of Pearson correlation analysis showed that BUT was positively correlated with lipid layer thickness and eye redness improvement, while Schirmer's test (Sit) was positively correlated with tear meniscus height. PL scores were negatively correlated with tear meniscus height but positively correlated with the eye redness index (P<0.05). AHI from PSG results was negatively correlated with BUT, PL scores, and OSDI scores (P<0.05), while SpO2 was positively correlated with BUT, PL scores, and OSDI scores but negatively correlated with Sit (P<0.05). In the PSG results, AHI was negatively correlated with lipid layer thickness and eye redness index, and positively correlated with meibomian gland opening score (P < 0.05).

Conclusion: CPAP mask usage in OSAS patients may negatively impact dry eye symptoms and meibomian gland function, leading to decreased tear film stability and worsening symptoms of eye dryness.

Keywords: CPAP; Dry eye symptoms; Mask; Meibomian gland function; OSAS.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants after a detailed explanation of the study’s purpose, methods, potential risks, and benefits. Conflict of interest: The authors report there are no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Flow chart of patient inclusion
Fig. 2
Fig. 2
Correlation coefficient matrix of dry eye symptoms and meibomian gland function after CPAP treatment
Fig. 3
Fig. 3
Correlation between AHI and changes in dry eye condition in PSG results. A: Correlation between AHI and BUT; B: Correlation between AHI and Sit; C: Correlation between AHI and PL score; D: Correlation between AHI and OSDI score
Fig. 4
Fig. 4
Correlation between SpO2 and changes in dry eye condition in PSG results. A: Correlation between SpO2 and BUT; B: Correlation between SpO2 and Sit; C: Correlation between SpO2 and PL score; D: Correlation between SpO2 and OSDI score
Fig. 5
Fig. 5
Correlation between AHI in PSG results and ocular surface analyzer examination results. A: Correlation between AHI and tear meniscus height; B: Correlation between AHI and lipid layer thickness; C: Correlation between AHI and eye redness index; D: Correlation between AHI and meibomian gland opening score
Fig. 6
Fig. 6
Correlation between SpO2 in PSG results and ocular surface analyzer examination results. A: Correlation between SpO2 and tear meniscus height; B: Correlation between SpO2 and lipid layer thickness; C: Correlation between SpO2 and eye redness index; D: Correlation between SpO2 and meibomian gland opening score
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