While many people are blaming their new found dry eye disease on the amount of time spent using devices as we work and study more from home during the COVID-19 pandemic, there is growing awareness of another significant cause – face masks.
Indeed, increasingly wide-spread use of face masks is contributing to what the Centre for Ocular Research & Education (CORE) in Canada has coined MADE – mask associated dry eye.1
MADE is caused when air is expelled upward from the mask and into the eye and, in those who tape their mask across the bridge of the nose, this can compromise movement of the lower lid, which inhibits a complete and natural blink
While essential for the prevention of COVID-19 transmission, face masks that are worn for an extended time are being found to contribute to the debilitating disease. Furthermore, dryness and irritation of the ocular surface associated with mask use is now raising concerns for increased risk of disease transmission through the ocular route.
It is thought that MADE is caused when air is expelled upward from the mask and into the eye and, in those who tape their mask across the bridge of the nose, this can compromise movement of the lower lid, which inhibits a complete and natural blink.
In a paper published in Ophthalmology and Therapy,2 study author Majid Moshirfar reported a marked increase in dry eye symptoms among people who regularly use masks for an extended time, at multiple local clinics. Patients included people who had never previously suffered from dry eyes, as well as the elderly, immunocompromised, and clinic staff.
“We saw numerous individuals at our practice who were regular mask wearers, including both patients and staff. These individuals described a subjective worsening in symptoms assessed in the Ocular Surface Disease Index. Patients showed a deterioration in corneal staining, as well as a distinct increase in dryness reported by cataract patients on postoperative day one. The majority of individuals described an awareness of air blowing upward from the mask into their eyes. 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. In addition to air convection, other factors are also likely at play. Staff members using taped masks to prevent air convection toward the eyes also complained of corneal irritation. In these cases, we postulate that the tape adhering to the skin of the upper cheek may interfere with the normal excursion of the lower eyelid, possibly inducing mechanical ectropion with secondary lagophthalmos.”
The authors also reported the potential heightened risk of COVID-19 transmission via the ocular surface when it is dry or irritated – both because of frequent eye rubbing that often occurs in response to ocular discomfort, and because a compromised tear film may not provide an adequate barrier against pathogenic invasion.
The authors recommended that people experiencing dry eye symptoms should take regular breaks from mask use, wear goggles in conjunction with masks, and regularly apply lubricant eye drops. Additionally, they recommended wearing masks with a pliable nose-wire that can be fitted to prevent air being directed toward the eyes. When tape is used to impede airflow, care should be taken to ensure that lid excursion is not inhibited.
2. Moshirfar Majid, West William B., Jr., and Marx Douglas P. Face mask-associated ocular irritation and dryness. Ophthalmology and Therapy. 2020 Sep; 9(3): 397–400.DOI 10.1007/s40123-020-00282-6