G.Sruthi, B. Optometry

Aravind Fellowship in Clinical Optometry, Aravind Eye Care System, Chennai, India

The COVID 19 pandemic has made everyone use face masks in our day-to-day activities. While it helps in controlling the spread of coronavirus, unfortunately, it is also giving rise to increased dry eyes among some. Researchers have coined the term Mask Associated Dry Eyes (MADE),⁽¹⁾ to describe the dry eye caused by wearing a face mask for prolonged periods of time. It was first observed and invented by D.E.White, an American Ophthalmologist in his blog. All face mask users are susceptible to dry eyes. A survey of 3605 people using masks has reported that about 18.3 percent of people experienced dry eye symptoms.⁽²⁾

People who are at risk for MADE symptoms are those who had a history of dry eye, poorer tear film quality, elderly people, contact lens users, post-menopausal females, post-IOL, and post LASIK cases. Some recent studies reveal that spectacle users experience MADE more than normal patients because spectacles reduce the outward spread of air than normal mask users. People working as medical professionals can easily be affected by MADE due to prolonged usage of masks and people spending more time on digital screens can also experience dry eyes.

What happens to the eye when wearing a mask!

Usually, when we exhale, air needs to disperse, but for the mask wearers, especially if it is a loose fit, the air gets a chance to move upward which leads to tear film evaporation, and thereby leads to dry spots on the ocular surface, irritation, itching, and redness.

Some of the symptoms of MADE are redness, irritation, itching, stinging, sensitivity to light (photophobia), eye pain, fatigued eyes, blurry vision, watery eyes, stringy mucus, and foreign body sensation. In severe cases, MADE can lead to decreased corneal sensation and tear film stability. Duration of mask usage also contributes to MADE. A study by Krolo et al has reported that subjects who wore a face mask from 3 to 6 hours/day demonstrated significantly higher ocular surface disease index (OSDI) scores compared to those who used the mask less frequently.

Types of masks can also have a great impact on MADE. We assume that cloth masks and surgical masks can have a greater outflow of air when compared to N95 and N100 respirator masks.

MADE can be reduced by using face masks in a proper way and with a pliable nose wire. It prevents the airflow directed towards the eye. Taping the mask prevents airflow. MADE can be prevented by using lubricating drops at least thrice a day while using a mask for a prolonged time. It can be managed by lubricating ointment or gel and emollient eye drops for preserving tear films.^(3-8)

Conclusion:

To conclude, MADE is due to the displacement and improper fitting of the mask. So, everyone should be aware of the importance of proper fit and the type of mask. Eye care professionals should be aware of this new phenomenon and advise the patients about the potential risks of wearing inadequately fitted face masks to their ocular surface health.

References

1. Mask Associated Dry Eye (made). Eyewiki. (2021, June 10). Retrieved January 28, 2022, from https://eyewiki.org/Mask_Associated_Dry_Eye_(MADE)
2. Boccardo, L. (2021). Self-reported symptoms of mask-associated dry eye: A survey study of 3,605 people. Contact Lens and Anterior Eye, 101408.
3. Bryn Mawr Communications. (n.d.). Practitioners should be aware of mask-associated dry eye (made). Eyewire+. Retrieved January 28, 2022, from https://eyewire.news/articles/core-alerts-practitioners-to-mask-associated-dry-eye-made/
4. Melissa Barnett, O. D. (n.d.). How to address face mask–Associated Dry Eye. Optometry Times. Retrieved January 28, 2022, from https://www.optometrytimes.com/view/how-to-address-face-mask-associated-dry-eye.
5. Moshirfar, M., West, W. B., & Marx, D. P. (2020). Face mask-associated ocular irritation and dryness. Ophthalmology and therapy, 9(3), 397-400.
6. How face masks affect the eyes-and how Doctor of Optometry can provide relief. AOA. (n.d.). Retrieved January 28, 2022, from https://www.aoa.org/news/clinical-eye-care/diseases-and-conditions/how-face-masks-affect-the-eyes?Sso=y
7. Face masks and Ocular Health: The effects of the pandemic on Our eyes. Imedpharma.com. (2021, September 9). Retrieved January 28, 2022, from https://imedpharma.com/face-masks-and-ocular-health-the-effects-of-the-pandemic-on-our-eyes/
8. William Ngo Assistant Professor. (2021, December 18). Face masks, digital screens and winter weather are a triple threat for Dry eyes. The Conversation. Retrieved January 28, 2022, from https://theconversation.com/face-masks-digital-screens-and-winter-weather-are-a-triple-threat-for-dry-eyes-173742.