Study Finds Mask Wearing Increases Risk of Dry Eye Syndrome

A study published in Scientific Reports and conducted in China found that mask-associated dry eye (MADE) was associated with use of glasses, age, female sex, nonstandard mask wearing, and preexisting dry eye. The study aimed to investigate the association between wearing face masks and dry eye susceptibility in daily mask wearers.

The study used an online questionnaire that was administered between January 29, 2021, and February 8, 2021. Data analyses were completed from February 14, 2021, to March 10, 2021.

The questionnaire, drafted by experts from Tianjin Eye Hospital, asked about age, sex, education, mask wearing time, symptoms and frequency of dry eye, and outdoor time. Symptom frequency was separated into groups of never (0 times per day), sometimes (0-4 times per day), or often (> 4 times per day).

There were 6925 questionnaires that were eligible for the analysis, and the median (IQR) participants age was 14 (12-26) years. There were 6072 participants who had never experienced dry eye symptoms after wearing a face mask, 419 who sometimes and often experienced dry eye symptoms, and 128 who experienced dry eye symptom aggravation. The overall rate of MADE was 7.90%.

More participants wore masks for 0 to 4 (n = 1964) than did for 4 to 6 (n = 1199), 6 to 8 (n = 1593), or at least 8 hours per day (n = 1217) (OR, 1.306; 95% CI, 1.221-1.397). The incidence of MADE increased with longer mask wearing.

Those with preexisting dry eye were prone to have MADE (OR, 4.822; 95% CI, 3.856-6.029). Among the participants, 84.19% had never experienced dry eye symptoms, 13.53% sometimes experienced symptoms, and 2.28% often experienced symptoms (OR, 4.647; 95% CI 4.035-5.352). There were also 214 participants who were treated with anti–dry eye drugs after wearing face masks (OR, 2.199; 95% CI, 1.501-3.220).

Pattern of mask wearing was separated into 3 groups: ill fitting (score 1-5), less standard (6-9), and standard (10-11). The fewest reported an ill-fitting pattern (6.50%) and the most reported standard wearing (58.93%) (OR, 0.804; 95% CI, 0.702-0.920). A higher incidence of MADE was related with nonstandard mask wearing.

MADE incidence was higher in those wearing glasses and contact lenses than in those wearing contact lenses alone (16.03% vs 10.61%), in those wearing only contact lenses vs wearing only glasses (10.61% vs 9.56%), and in those wearing glasses vs wearing neither glasses nor contact lenses (9.56% vs 6.32%).

Further, MADE incidence was higher in dry areas in adults older than 20 years (OR, 2.264; 95% CI, 1.327) than in younger adults (OR, 3.612; 95% CI, 2.100-6.212). MADE was also more common in women than in men (OR, 1.323; 95% CI, 1.107-1.580).

A university undergraduate or graduate degree was more associated with MADE than other education levels. There also was a significant difference in the incidence of MADE between those with less and more outdoor time (OR, 1.747; 95% CI, 1.081-2.824).

There were some limitations to this study. Occupational categories and clinical confirmation of dry eyes were lacking, and data were not collected on medical history, such as ophthalmic surgery history and systemic disease history.

The study authors recommended that a comparison of occurrence of MADE in populations where masks use has identical use rates could be a future area of investigation, as should climate, cultural background, cultural behavioral elements, race, occupation, and educational level influences.

The researchers concluded that risk factors of MADE included longer mask wearing time, nonstandard wearing of masks, dry environment, older age, female sex, higher education, and less outdoor time.

“Choosing the proper type of face mask, standardizing the fitting pattern of mask wearing, reducing continuous mask wear time, increasing proper time intervals for mask removal, and lubricating the eyes with eye drops to help tear film recovery are recommended and may help in preventing MADE,” the authors wrote.

Reference

Fan Q, Liang M, Kong W, et al. Wearing face masks and possibility for dry eye during the COVID-19 pandemic. Sci Rep. Published online April 13, 2022. doi:10.1038/s41598-022-07724-0