COVID-19 and Masks Aggravate Dry Eye

As the winter months approach and the time we spend indoors increases, so do the cases of dry eye.  There are several environmental and medical reasons people struggle with dry eye, but heated forced air is one of the top culprits.  We cannot escape as we are assaulted by dry air everywhere, we turn, our home, our cars, our grocery stores, and the dry winter outdoor air.  Yet this year dry eye sufferers will face another challenge- the necessity of wearing a mask.  Eye care professionals recognize that wearing masks can aggravate dryness of the eye.

An article published by Moshirfar et al. in Ophthalmology and Therapy in September 2020 said that “with COVID-19 and accompanying face mask use likely projecting well into the future, eye dryness, irritation and keratopathy from mask wear may become a problem for a large percentage of the population.” The authors go on to say that “in our community and patient population, we have seen a marked increase in dry eye symptoms among regular mask users at multiple local clinics. This group includes individuals who have never previously suffered from dry eyes. Individuals using masks regularly for an extended duration appear more likely to show symptoms. This group includes the elderly, immunocompromised, and clinic staff who wear masks almost full-time.”

While wearing a mask has been suggested as the best way to limit COVID-19 transmission, it can be a nuisance to many, especially those working through fogged glasses.  Some people need to wear a mask for long periods of time: grocery store employees, healthcare professionals, and those who serve the public to name a few.  Although masks are protecting our health at large, our eye health needs to be given a little more attention and TLC.  As we exhale while wearing a mask, only a limited amount of our breath passes forward through the mask.  Some air will escape the mask- on the bottom, the sides, and through the top of the mask since it may not be secured close enough to our face because of our nose. Masks come in a variety of shapes, sizes, and materials. Some have nose pieces built-in made of metal or another pliable material that can be bent to contour the shape and size of the wearer’s nose producing a better fit. However, for those masks that do not have a nose piece or for those masks that are improperly fit in some other way, exhaled air can be forced upwards towards our eyes. Moshirfar et al. postulate that “this increased airflow likely accelerates the evaporation of the tear film which, when continuous for hours or days, may result in ocular surface irritation or inflammation.”

A quick fix may be to tape the top of the mask below our eyes to limit the air from escaping, but this may not offer a viable solution either. Moshirfar et al. tried this in their clinic with their post-op cataract patients and found that those patients still suffered dryness. They thought that perhaps the medical tape secured to the skin of the nose and upper cheek may have pulled the lower lid away from eye inducing mild ectropion which can lead to dryness and keratopathy.

It is important that you consult with an eye care professional if you are suffering from eye irritation and dryness.  Most cases can be treated with a properly fitted mask preferably with a nose piece, taking breaks from mask-wearing, and ensuring the eyes are properly lubricated using preservative-free eye drops. If your case is more chronic, it is important not to wait as early detection offers more treatment options.


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