The Effect of Mask Use on the Ocular Surface During the COVID-19 Pandemic

The new coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China in October 2019 and spread rapidly all over the world, making extended mask use an inescapable rule of daily life. Literature data indicate that the use of face masks increases the symptoms of dry eye in addition to preventing the spread of COVID-19. The aim of our study was to evaluate the relationship between the clinical signs and symptoms of dry eye and the duration of mask use in healthy individuals using regular face masks.

Thirty-five patients aged 20-60 years with no additional ophthalmologic pathology were included in the study. Participants were stratified by duration of face mask use: ≤6 hours/day (group 1) and >6 hours/day (group 2). The patients were assessed with the Ocular Surface Disease Index (OSDI) questionnaire, fluorescein ocular surface staining, and tear break-up time (TBUT) to evaluate the effect of extended mask use on the ocular surface.

A total of 62 eyes of 35 patients, 20 women (57.1%) and 15 men (42.9%), were included in the study. The two mask use duration groups had similar OSDI values (p=0.736). When the ocular surface staining pattern was examined according to the Oxford scale, 50% (10/20) of the eyes in group 1 were assessed as stage 1 and the other 10 eyes as stage 0. In group 2, 47.6% (20/42) of the eyes were assessed as grade 1, 11.9% (5/42) as grade 2, and 4.7% (2/42) as grade 3.

Prolonged face mask use was shown to cause decreased TBUT and increased ocular surface staining even in healthy individuals. Further studies are needed to investigate changes in the tear film after extended daily mask use.