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

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 coro-navirus 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 face-masks 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 dura-tion. 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.