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FACE MASKS AND OCULAR HEALTH: THE EFFECTS OF THE PANDEMIC ON OUR EYES

FACE MASKS AND OCULAR HEALTH: THE EFFECTS OF THE PANDEMIC ON OUR EYES

The current coronavirus disease (COVID-19) pandemic and the worldwide efforts made to reduce the spread of infection has had an impact on many aspects of our everyday lives, including our eyes. Many of the practices that are recommended by health officials and organizations help to ensure both our own health and safety as well as protect the health and safety of others. This is both necessary and important for disease control, but it is also important to understand how this pandemic can impact our ocular health.

COVID-19 and the protective steps we take against the virus can affect our eyes in several ways. For example, the virus can infect us by using the eyes as a site of entry.[1] Also, some of the protective measures in place, such as increased use of digital screens to help maintain social distancing[2] and wearing a face mask can increase the occurrences and symptoms of dry eye disease.[3] Stopping ocular surface drying is an important step in managing eye discomfort and in ensuring optimal ocular health.

Face Masks – Possible Ocular Risks

Responsibly wearing a mask, along with physical distancing guidelines, are interventions the general public can use to help protect against the infection of COVID-19.[4] While the overall goal of using face masks is to block the transmission of infectious droplets from reaching other people and contaminating surfaces,[5] all types of protective face masks create some uncomfortable conditions during wear.

One discomfort commonly felt during the wearing experience is the build-up of moist, warm air inside the mask area from exhalation.[6] Another common mask wearing experience is misting or fogging up of the glasses.[7] While the fogging lens of glasses visibly shows the outward spread of air from exhaled breath, this air is also felt on the surface of the eyes.[8] A stream of air blowing along the eyes creates conditions that accelerate tear film evaporation, leading to a poorer quality tear film and ocular surface dryness which, over time and long-term mask use, can increase the symptoms associated with dry eye disease. In addition, discomfort from dry eyes can encourage eye rubbing and face touching, behaviours that increase the potential of COVID-19 infection through the eyes.[9]

Ensuring Good Mask Fit and Preventative Ocular Measures

Wearing a properly fitting mask can help stop the outward stream of air directed towards the surface of the eyes. When a mask sits loosely, or when the mask has gaps along the top or the sides of the face, it can cause mask associated dry eyes.[10]                   

Additionally, the gaps also allow the emission and entering of virus particles.[11] This not only defeats the purpose of the mask to protect yourself and others, but also causes problems for your eyes by drying the ocular surface. To solve this issue, wear masks that have a good fit and that sit close to the facial contours (such as ones with a pliable nose-wire), or achieve a close fit by carefully taping along the top edge in a way that does not interfere with blinking. This is important for both particle filtration as well as comfort and avoids the problem of exhaled air streaming towards the eyes.[12] In addition, using viscoadaptive lubricating eye drops while wearing a mask can help to prevent drying of the ocular surface by preserving the tear film and protecting the surface of the eye.

Ensuring ocular health and comfort with a combination of steps such as taking regular breaks from digital screens, wearing a good fitting mask, and using lubricating eye drops such as

I-DROP® PUR for mild to moderate dry eyes and for use with contact lenses, or I-DROP® PUR GEL for moderate to severe dry eyes can all help to protect the surface of the eye from drying while a mask is worn. Please consult with your advising eye care professional for more information on the use of artificial tears and preventing dry eye disease.

 

[1] Wu, Ping, Fang Duan, Chunhua Luo, Qiang Liu, Xingguang Qu, Liang, and Kaili Wu. “Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China.” JAMA Ophthalmology 138, no. 5 (May 1, 2020): 575–578. DOI:10.1001/jamaophthalmol.2020.1291.

[2] Giannaccare, Giuseppe, Sabrina Vaccaro, Alessandra Mancini, and Vincenzo Scorcia. “Dry Eye in the COVID-19 Era: How the Measures For Controlling Pandemic Might Harm Ocular Surface.” Graefe’s Archive For Clinical and Experimental Ophthalmology (June 19, 2020). https://doi.org/10.1007/s00417-020-04808-3.

[3] CORE Alerts Practitioners to Mask-Associated Dry Eye (MADE). August 31, 2020, https://core.uwaterloo.ca/news/core-alerts-practitioners-to-mask-associated-dry-eye-made/.

[4] Chu, Derek K, Elie A Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, and Holger J Schünemann. “Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-CoV-2 and COVID-19: A Systematic Review and Meta-Analysis.” The Lancet 395, no. 10242 (June 27, 2020): 1973–1987. https://doi.org/10.1016/S0140-6736(20)31142-9.

[5] Javid, Babak, Michael P Weekes, and Nicholas J Matheson. “Covid-19: Should the Public Wear Face Masks?” BMJ 369 (April 9, 2020): m1442. DOI: 10.1136/bmj.m1442..

[6] Ong, Jonathan J.Y, Chandra Bharatendu, Yihui Goh, Jonathan Z.Y Tang, Kenneth W.X Sooi, Yi Lin Tan, Benjamin Y.Q Tan, et al. “Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19.” Headache 60, no. 5 (2020): 864–877. DOI: 10.1111/head.13811.

[7] Matusiak, Łukasz, Marta Szepietowska, Piotr Krajewski, Rafał Białynicki‐Birula, and Jacek C Szepietowski. “Inconveniences Due to the Use of Face Masks During the COVID‐19 Pandemic: A Survey Study of 876 Young People.” Dermatologic Therapy 33, no. 4 (July 2020). DOI: 10.1111/dth.13567.

[8] Moshirfar, Majid, William B West, and Douglas P Marx. “Face Mask-Associated Ocular Irritation and Dryness.” Ophthalmology and Therapy 9, no. 3 (September 2020): 397–400. https://doi.org/10.1007/s40123-020-00282-6.

[9] Moshirfar et al., “Face Mask-Associated,” 397-400.

[10] CORE Alerts.

[11] Lee, Ka-Po, Joanne Yip, Chi-Wai Kan, Jia-Chi Chiou, and Ka-Fu Yung. “Reusable Face Masks as Alternative for Disposable Medical Masks: Factors That Affect Their Wear-Comfort.” International Journal of Environmental Research and Public Health 17, no. 18 (September 11, 2020): 6623. https://doi.org/10.3390/ijerph17186623.

[12] Moshirfar et al., “Face Mask-Associated,” 397-400.

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