Experts from the Centre for Ocular Research and Education (Core) released the results of a review in late August that concluded eye dryness and irritation from mask wear may become a problem for a large percentage of the population.
Mask-associated dry eye (Made) became an issue as national governments and health services began recommending mask wear in public to combat the coronavirus pandemic, and Core recommended that eye care professionals (ECP) were aware of the signs and symptoms of the condition.
The utility of masks in slowing transmission of the virus has been well documented, and the rise in cases of Made is a downside that eye care professionals will have to address while wearing them is still recommended, said Dr Lyndon Jones, director of Core. ‘Asking patients about their mask-wearing experiences and providing a few helpful tips takes little time and can make a substantial difference,’ he added.
Dr Lyndon Jones
The problem
Made is caused by the upward flow of air that escapes from loosely-worn masks. This stream of air is dispersed over the surface of the eye, creating conditions that accelerate tear film evaporation leading to dry spots and discomfort. Beyond causing discomfort, Made may encourage people to rub their eyes for relief, raising the possibility of unwashed hands being brought to the face and increasing the likelihood of coronavirus infection.
Dr Jones said epidemiological data did not exist on the prevalence of Made over the recent months, but: ‘Increasing anecdotal reports by clinicians would suggest that it is becoming a fairly common condition.
‘Increasing incidence is expected over the next few months as mask-wearing becomes more widespread and as people return to the workplace where mask wear may be required for extended time periods each day.’
Research
Based on the results of Core’s study, Made appeared most likely to affect those with pre-existing dry eye symptoms and people with borderline dry eye for whom mask wearing disturbed the tear film to the point where it tips them into becoming symptomatic. Those who need to wear a mask in an environment where they are undertaking a lot of digital device use, which is known to alter blinking patterns and produce an unstable tear film, are also at risk. Elderly patients, who may already have a lower quality tear film, and contact lens wearers, whose tear film is physically disturbed by the lens on the eye, may also be at higher risk of Made.
Core explained that patients wearing masks for extended periods could be more likely to experience these symptoms, making eye protection and management of dryness an important consideration for long-term mask users. Dr Jones explained that patients who wear spectacles do not appear to be at higher risk of Made, but that fogging can become an issue here. ‘Spectacle wearers are at risk of becoming dissatisfied with
mask-wearing because of fogging. For both Made and lens fogging, the upward motion of air escaping from a loosely fitted mask is the root cause of the problem,’ explained Dr Jones.
The solution
While Made has increased in prominence, Dr Jones said the steps needed to alleviate the issue are simple. Patients should ensure masks fit closely, especially along the top edge, and can consider lightly taping the mask to their face with surgical tape. Core also recommended using an ocular lubricant on a regular basis and taking regular breaks from digital devices to re-establish a normal blink-rate.
Dr Jones said: ‘Given that masks only cover the mouth and nose, it is quite possible a patient may not link any dry eye symptoms with mask wearing. It appears that mask wearing will be recommended for some time ahead, and thus Made is likely not disappearing any time soon. Hence, eye care practitioners should consider questioning patients on a routine basis about any dryness symptoms with mask wear, as they are the most appropriate professional to manage this condition.’
Made should also not be deployed as an argument for not wearing masks, as Dr Jones explained: ‘Epidemiological evidence suggests that mask wearing is valuable in reducing the spread of coronavirus. Given that Made can be easily managed once wearers understand the link between masks and dry eye, the known benefits of mask-wearing certainly appear to outweigh the downsides of minor dry eye symptoms.’