At the time of this writing in February 2021, the global impact of COVID-19 has been astronomical, with more than 109 million cases worldwide and more than 2.4 million deaths (World Health Organization [WHO], 2021). The rapid expansion of COVID-19 across the globe is largely due to the manner in which is spreads; the infection is thought to be acquired primarily via respiratory droplets expelled when an infected person speaks, coughs, or sneezes (Li et al, 2020). When these droplets come to rest on the oral, nasal, pulmonary, or ocular mucosa membranes, infection may occur (WHO, 2021).
Face masks are an important, efficacious means of reducing the risk for acquiring droplet-associated COVID-19 (Li et al, 2020; Stutt et al, 2020). Wearing them also has the potential to impact the ocular surface.
Mask Wear and the Eye
Chadwick and Lockington (2020) described Mask-Associated Dry Eye (MADE), a condition that results from poorly fitting masks causing leakage of air onto the ocular surface. They reported a case of a 66-year-old female who developed cataracts during the COVID-19 pandemic. Following cataract surgery, she initially experienced “clear vision”; but within a few hours, and while wearing a mask, she developed significantly reduced vision and discomfort. Biomicroscopy revealed superficial corneal staining and haze. Further examination revealed reduced tears in the operated eye. The surgeon noted that her face mask was loosely fitting. Treatment for dry eye in the operated eye combined with reduced face mask wear resulted in improved comfort and vision.
The drying effect of mask wear is not limited to patients; Moshirfar et al (2020) reported a marked increase in dry eye signs and symptoms in mask-wearing patients and staff members within their multi-clinic practice. They noted a similarly increased frequency in individuals who wear masks on an extended basis (i.e., elderly and immunocompromised individuals). Clinical staff members whose tasks require that they wear a mask for an extended basis also experienced a similar increase.
An unfortunate complication of mask wear may be increased eye rubbing and face touching. Lazzarino et al (2020) described how air expelled from a face mask is forced upward onto the ocular surface, potentially increasing drying and discomfort and often leading to increased eye touching or rubbing. If an individual’s hands are contaminated with COVID-19, this behavior may ultimately lead to systemic infection via the ocular surface.
Screen Time and Kids
The COVID-19 pandemic has fundamentally changed how young people are being educated, with many students receiving at least a portion of their education online. Ichhpujani et al (2020) evaluated the impact of digital device use in students aged 11-to-17 years. Twenty percent of 11-year-olds reported using devices on a daily basis compared to 50% of 17-year-olds. Overall, 18% of subjects reported some degree of eyestrain by the end of the day.
Stay One Step Ahead
This information is valuable, particularly at this time, because the preemptive management of dry eye and ocular surface disease can improve function by reducing damage to the ocular surface, enhancing comfort and vision. On a different level, management of mask-associated ocular surface disease has the potential to reduce ocular transmission of COVID-19. CLS
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