Introduction
Face masks significantly reduced viral transmission during the COVID-19 era and were one of the primary public health strategies to stop the virus' spread. Although mask usage is declining worldwide, it has become more prevalent in hospital settings, particularly where patients and healthcare professionals frequently don them for extended periods.
Additionally, there is proof that ocular problems, including red eyes, irritation, tears, and eye pain, have been more common during the pandemic, with some cases of these complaints being linked to face masks. According to some scientists, the rise in ocular pain sensations is mostly caused by dry eye illness linked to face masks and is correlated with prolonged face mask use.
The effects of face masks on the ocular surface are a significant public health concern since they may cause frequent mask removal and eye rubbing owing to ocular pain and irritation from extended face mask usage and the fogging of glasses. This works against efforts to improve public health.
What Is the Pathophysiology Associated With Face Mask-Inducing Ocular Problems?
Several hypotheses exist on how wearing a face mask affects the ocular surface. The most prevalent theory contends that using a face mask causes an abnormal upward airflow towards the ocular surface during expiration, which may become more pronounced when the face mask is worn improperly or inadequately fitting. This upward airflow may use multiple processes to affect the ocular and periocular surface's normal physiological state.
1. First, the exhaled air that escapes upward from the mask's edge may encourage the evaporation of tears, which might cause irritation, discomfort, and symptoms of dry eyes.
2. This air convection may promote aqueous tear evaporation by disrupting the lipid layer on the tear's surface or by maintaining a water vapor pressure differential.
3. Changes to the aqueous-mucin layer will likewise lessen wettability. Continuous positive airway pressure (CPAP) therapy is known to be linked to ocular surface issues because of the increased airflow around the eye, similar to the usage of facial masks.
4. Continuous positive airway pressure treatment has been shown to worsen ocular discomfort, epiphora, tear evaporation, and conjunctival squamous metaplasia.
A second potential mechanism is based on the fact that exhaled air contains more carbon dioxide than inhaled air. Within a face mask, carbon dioxide concentrations may be up to 10 times greater.
Inflammation is another thing that hypercapnia is known to do. However, it is speculated that the elevated carbon dioxide in the exhaled air that passes over the ocular surface may cause modifications associated with hypercapnia and affect the chemical composition.
Since exhaled air is often warmer than the surrounding air, these temperature fluctuations may also encourage the evaporation of tears.
What Are the Effects of Face Mask Use on the Ocular Surface of Healthy Individuals?
The following are the effects of face mask use on the ocular surface of healthy individuals:
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Signs of dry eyes.
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Shifts in the stability of the tear film.
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Epithelial damage to the cornea.
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Temperature changes within the eye.
What Is Dry Eye?
According to the National Eye Institute (NEI), dry eye is a disorder that develops when the tears are not sufficient in quantity or quality. This can occur if any of the tear film's layers, which are made up of multiple different components, have a problem.
Dry eye is widespread and can result in unpleasant symptoms, such as:
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A scratchy sensation as though something is in the eye.
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Scorching or stinging sensations in the eyes.
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Eye color.
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Responsiveness to light.
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Hazy vision.
What Is Mask-Associated Dry Eye?
An airflow problem may be the root of this mask-induced dry eye. If the mask does not fit snugly, air may flow up and over the eyes' surface when a person exhales. That promotes evaporation and eventually leads to eye dryness. Taped masks for a better seal were associated with eye problems. The tape may obstruct the lower eyelid's typical function, resulting in dry eyes.
Even the function of the eyelids might be hampered by a poor mask fit. According to some medical professionals, the masks may also slightly pull down the lower eyelids, which makes it more challenging for regular blinking to repair the eye's healthy surface.
How to Prevent or Treat Mask-Associated Dry Eye?
The treatment depends on the severity of the symptoms, as it may be a painful problem.
1. Hot compresses can be applied to the eyes at night by moistening a washcloth with warm or hot water and placing it over the eyes for a few minutes. The Meibomian glands on the eyelids, which produce the greasy outer layer of tears, can be stimulated to cause the glands to release more oil. Additionally, the lubrication on the eyes should last longer due to the increased oil content in the tears.
2. Oil-based lubricants may be more effective as they aid in tear evaporation, and using lubricating eye drops a few times daily may also be helpful.
3. Wearing sealed goggles may be helpful if a person's dry eye caused by their mask is severe. It keeps the virus out and the moisture in if fitted properly. A person's eye doctor can advise trying a scleral lens, a fluid-filled gas-permeable contact lens, to encapsulate his eyes in fluid if they are still having trouble. This corrects eyesight and gives the patient constant hydration throughout the day.
Conclusion
The COVID-19 pandemic has seen an increase in reports of dry eye symptoms, which is likely multifactorial. Additionally, different people may respond differently to face masks. It is crucial to use a face mask if we want to stop the COVID-19 virus from spreading. However, wearing a mask might have undesirable side effects, such as maskne, hazy glasses, and overall facial irritability. Mask-associated dry eye, sometimes called MADE, is another adverse impact to watch out for. The prevention of corneal abrasions from wearing a mask while removing or changing it can also be aided by education on proper mask-wearing procedures. The ophthalmologist must ensure the face mask is put on properly, especially if glasses or sunglasses are used. Lubricating eye drops should be used often to reduce MADE. To know more about the condition, consult the doctor online.
