Dry Eye–Aggravated with Mask Wearing

As the crisp, cool air of Fall descends upon us in the Northeast, so does the time for us to get out our sweaters, cup our warm beverages and watch for the changing foliage… and an increase in dry eye. Eye care professionals and many of our well-educated patients already know that dry eye can be exacerbated this time of year by the forced air heating systems in our houses and cars but, the thing that may make people suffer more this year is the fact that wearing masks can also aggravate dryness.

An article published by Moshirfar et al. in Ophthalmology and Therapy in September 2020 said that “with COVID-19 and accompanying face mask use likely projecting well into the future, eye dryness, irritation and keratopathy from mask wear may become a problem for a large percentage of the population.” The authors go on to say that “in our community and patient population, we have seen a marked increase in dry eye symptoms among regular mask users at multiple local clinics. This group includes individuals who have never previously suffered from dry eyes. Individuals using masks regularly for an extended duration appear more likely to show symptoms. This group includes the elderly, immunocompromised, and clinic staff who wear masks almost full-time.”

It seems that as we exhale with a mask on only a limited amount of our breath passes forward through the mask, some air escapes through gaps in the masks on the bottom, the sides, and perhaps most pronounced, through the top of the mask since it may not be secured close enough to our face because of our nose. Masks come in a variety of shapes, sizes, and materials. Some have nose pieces built-in made of metal or another pliable material that can be bent to contour the shape and size of the wearer’s nose producing a better fit. However, for those masks that do not have a nose piece or for those masks that are improperly fit in some other way, exhaled air can be forced upwards towards our eyes. Moshirfar et al. postulate that “this increased airflow likely accelerates the evaporation of the tear film which, when continuous for hours or days, may result in ocular surface irritation or inflammation.”

Taping the mask to the nose may not offer a viable solution either. Moshirfar et al. tried this in their clinic with their post-op cataract patients and found that those patients still suffered dryness. They thought that perhaps the medical tape secured to the skin of the nose and upper cheek may have pulled the lower lid away from eye inducing mild ectropion which can lead to dryness and keratopathy.

Eye care professionals will carefully monitor patients for signs of dry eye and people who feel they may be suffering from any eye irritation including dryness should be seen. A properly fitted mask (with nose piece if possible), lubricating eye drops and frequent masks breaks can help to relieve dry eye. However, if these do not alleviate all of the signs and symptoms of dryness, further action may need to be taken to help ensure the person’s comfort and ocular health long term. Masks are not going anywhere for a while, so we all have to learn to live with them as best we can since they are an essential component in preventing COVID-19 transmission.

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Merrick, NY 11566

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