MADE-up or real? Review debunks severity of mask-associated dry eye syndrome

NewsGuard 100/100 Score

A comprehensive review article published in the journal Eye claims that prolonged face mask wearing due to the coronavirus disease 2019 (COVID-19) pandemic is unlikely to cause any serious complications in the eyes.

Study: Real or MADE-up: Investigating Mask-Associated Dry Eye (MADE) as an emerging syndrome. Image Credit: eldar nurkovic / ShutterstockStudy: Real or MADE-up: Investigating Mask-Associated Dry Eye (MADE) as an emerging syndrome. Image Credit: eldar nurkovic / Shutterstock

Background

Widespread use of face masks during the most recent COVID-19 pandemic has brought about a new eye health condition called Mask-Associated Dry Eye (MADE). This condition is characterized by many symptoms, including dryness, redness, and ocular surface irritation caused by prolonged wearing of face masks.     

Pre-existing evidence suggests that Mask-Associated Dry Eye might occur due to the upward flow of air from the mask to the eyes. However, no previous evidence on such eye conditions is available for surgeons who have been using surgical masks for years.

In this review article, the authors critically analyze available evidence on mask-associated dry eye to understand the actual magnitude of its prevalence and severity.     

The authors searched various scientific databases to identify full-text articles that reported Mask-Associated Dry Eye. They identified a total of 26 studies involving 14,919 participants and grouped them by study design, objective measures, subjective measures, and miscellaneous parameters.

Important observations on objective measures

Tear break-up time (TBUT) and Schirmer’s test were the most commonly used clinical examinations in the selected studies to investigate the impact of face mask use on objective measures of ocular surface irritation.

TBUT is a standard diagnostic procedure for dry eye conditions. It defines the time the first dry spot takes to appear on the cornea following a complete blink. In dry eyes, TBUT is typically less than 10 seconds. Schirmer’s test is another type of examination for dry eyes that determines whether the eyes are producing sufficient tears to maintain moisturization. A 5 mm of tear production in 5 minutes is considered to be the dry-normal cut-off value in Schirmer’s test.

Of 26 studies included in the review, 15 compared the differences in TBUT between mask-on and mask-off conditions or between shorter and longer durations of mask use. A median reduction of 1.3 seconds in TBUT due to mask use was reported by 12 studies, which appears to be clinically non-significant. As mentioned in the review, such a slight change in TBUT is not expected to cause any significant complications on the ocular surface. Thus, the findings of selected studies indicate that mask use may cause very mild changes in the tear film that covers the ocular surface for protection and lubrication.

A total of 8 studies used Schirmer’s test, of which five reported a significant reduction in tear production, and two reported a significant increase in tear production due to mask wear. An induction in tear production due to mask use is expected as the redirected exhaled air can irritate the eyes and subsequently trigger reflex tearing. In contrast, a reduction in tear production may be explained by reduced hydration, possibly as a result of behavioral changes due to mask use.   

A total of 7 studies conducted corneal and conjunctival staining, of which six reported worsening due to face mask use.

Important observations on subjective measures

The Ocular Surface Disease Index (OSDI) was the most commonly used questionnaire in the selected studies. A total of 15 studies used this questionnaire to differentiate between eye conditions in mask-on and mask-off conditions. However, the majority of these studies incorrectly used the questionnaire.

Among these studies, five analyzed independent associations between mask use durations and OSDI scores. The findings revealed that heavy mask use for more than 6 hours a day is associated with significant worsening of dry eye symptoms.

Furthermore, some studies analyzed the impact of mask use on inflammatory markers, ocular surface temperature, tear soluble factors, tear osmolarity, and tear ferning tests. These studies produced mixed results. While some studies showed ocular surface pathologies due to mask use, some could not find any significant changes.

Significance

The authors have analyzed available scientific evidence on Mask-Associated Dry Eye and suggested that prolonged face mask use may cause mild ocular surface irritation; however, severe ocular surface pathology is very unlikely to occur following mask use.

An increased airflow from the mask towards the eye may trigger tear film evaporation, which in turn may cause mild ocular surface irritation or inflammation. An increased level of carbon dioxide within the face mask may also affect the ocular surface.

Considering the overall quality and certainty of selected studies, the authors mention that there is currently insufficient data to support the emergence of a new syndrome.

Journal reference:
Dr. Sanchari Sinha Dutta

Written by

Dr. Sanchari Sinha Dutta

Dr. Sanchari Sinha Dutta is a science communicator who believes in spreading the power of science in every corner of the world. She has a Bachelor of Science (B.Sc.) degree and a Master's of Science (M.Sc.) in biology and human physiology. Following her Master's degree, Sanchari went on to study a Ph.D. in human physiology. She has authored more than 10 original research articles, all of which have been published in world renowned international journals.

Citations

Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Dutta, Sanchari Sinha Dutta. (2024, January 09). MADE-up or real? Review debunks severity of mask-associated dry eye syndrome. News-Medical. Retrieved on April 17, 2024 from https://www.news-medical.net/news/20240109/MADE-up-or-real-Review-debunks-severity-of-mask-associated-dry-eye-syndrome.aspx.

  • MLA

    Dutta, Sanchari Sinha Dutta. "MADE-up or real? Review debunks severity of mask-associated dry eye syndrome". News-Medical. 17 April 2024. <https://www.news-medical.net/news/20240109/MADE-up-or-real-Review-debunks-severity-of-mask-associated-dry-eye-syndrome.aspx>.

  • Chicago

    Dutta, Sanchari Sinha Dutta. "MADE-up or real? Review debunks severity of mask-associated dry eye syndrome". News-Medical. https://www.news-medical.net/news/20240109/MADE-up-or-real-Review-debunks-severity-of-mask-associated-dry-eye-syndrome.aspx. (accessed April 17, 2024).

  • Harvard

    Dutta, Sanchari Sinha Dutta. 2024. MADE-up or real? Review debunks severity of mask-associated dry eye syndrome. News-Medical, viewed 17 April 2024, https://www.news-medical.net/news/20240109/MADE-up-or-real-Review-debunks-severity-of-mask-associated-dry-eye-syndrome.aspx.

Comments

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment
Post

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.

You might also like...
Study highlights how age affects nasal cell response to SARS-CoV-2