Mask-associated dry eye advice

The widespread use of face masks is causing eye dryness and irritation for an increasing number of people, claim researchers.

Reports of mask-associated dry eye (MADE) have circulated since early summer, with a recent review by Utah-based scientists concluding eye dryness and irritation from mask wear may become a problem for a large percentage of the population.

“Face masks are crucial in the fight against Covid-19 and eye health practitioners are well-positioned to provide patients with advice on appropriate wear in order to maximise eye comfort,” said Professor Lyndon Jones, director of the Centre for Ocular Research & Education (CORE) at Waterloo University, Canada. “Asking patients about their mask-wearing experiences and providing a few helpful tips takes little time and can make a substantial difference.”

Masks significantly reduce the outward spread of air, but exhaled air still needs to disperse, so when a mask sits loosely against the face the likely route is upwards. This forces a stream of air over the surface of the eye, creating conditions that accelerate tear film evaporation, leading to dry spots on the ocular surface and discomfort, said Prof Jones.

As well as worsening symptoms in patients with pre-existing dry eye disease, mask wear can affect the elderly who typically have a poorer quality tear film, contact lens wearers and masked people working extended hours in air-conditioned settings or using digital screens. To combat this, CORE researchers suggest practitioners include three additional actions in eye exams:

Consider face masks if faced with worsening symptoms and signs in your dry eye patients, or if patients report dry, uncomfortable eyes or variable vision for the first time
Routinely ask all patients how their eyes feel while wearing a mask, since many may not think to volunteer their experiences or associate their symptoms with mask use
Provide advice on alleviating symptoms, using a CORE-developed infographic showing how a few simple steps can help provide relief and minimise reoccurrence

“Responsibly wearing a mask, even when having to contend with eye dryness, is a critical part of overcoming the global pandemic. The good news is that we understand MADE and can address it,” said Prof Jones. “It’s an opportunity for eyecare practitioners to further communicate their knowledge and ongoing value to patients at a time when sound, scientific guidance is needed more than ever.”

Tips for patients and infographics are available at https://core.uwaterloo.ca/covid-19/