A comprehensive literature review of published studies dealing with mask-associated dry eye (MADE) found evidence that face mask usage causes an increase in symptoms of dry eye disease (DED). Since mask usage continues to be the norm in multiple settings, the authors call for continued research into the effects on the ocular surface.
Tell me about the paper.
The paper reviewed a total of 67 articles on PubMed that consisted of “studies regarding the use of face masks and outcome measures pertaining to the ocular surface.” Articles were narrowed down by identifying those containing a combination of two keyword groups: “dry eye,” “ocular,” “cornea” or “tear” and “mask.”
What did they find?
Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation of Eye Dryeness (SPEED) scores worsened with the extended use of face masks across multiple studies of healthy patients, while many studies found that tear break-up time (TBUT) and Schirmer 1 worsened after extended usage, while others had more contradictory results.
In the few studies of mask usage by patients with DED, they were more likely to report a worsening of their symptoms after prolonged mask usage.
Any limitations?
Most studies investigating MADE used a healthy patient population rather than a population of patients already diagnosed with DED.
The take home.
Face mask usage isn’t going away, the authors noted, and so continued research on the impact of face masks on the ocular surface is necessary. They wrote: “Studies should be controlled for [quarantine-related stress, depression and anxiety] in order to truly evaluate the prevalence and characteristics of MADE.”
In addition, the authors urged the eyecare community to come to a consensus on a set diagnostic criteria for MADE.
They concluded: “Despite common MADE symptoms in many patients, frequent wearing of face masks should not be dissuaded, as it is a crucial protective factor against COVID-19 and other respiratory viruses’ transmission. Instead, awareness among ophthalmologists of this condition and possible measures should be increased.”