EyeWorld Asia-Pacific September 2021 Issue

CORNEA 40 EWAP SEPTEMBER 2021 by Liz Hillman EyeWorld Editorial Co-Director Mask use associated with dry eye in certain patient populations Contact information Moshirfar: cornea2020@me.com Silkiss: rsilkiss@aol.com M ask use quickly became a mainstay during the COVID-19 pandemic. These face coverings play a role in saving lives, but they have been associated with some unintended ocular consequences as well. The CDC updated its mask guidelines in May 2021 for fully vaccinated individuals. According to the CDC, fully vaccinated people “can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.” 1 As of the time of publication, the CDC still recommends unvaccinated individuals “wear masks in public settings, at events and gatherings, and anywhere they will be around other people.” 2 Majid Moshirfar, MD, and Rona Silkiss, MD, who both published papers observing ocular conditions associated with mask use, emphasized the importance of mask wearing. Dr. Silkiss’ publication demonstrated an increased incidence of chalazion following widespread mask wear. 3 The retrospective multicenter study evaluated EMR data from a San Francisco community and Los Angeles academic practice from June–August 2020 compared to the same months in 2016, 2017, 2018, and 2019. There was a statistically significant rise in chalazion incidence in 2020 when mask wearing was prevalent. “It will be interesting to see if the rise in chalazion incidence declines as the incidence of COVID-19 declines and vaccinated individuals are able to curtail their mask wear,” Dr. Silkiss said. Dr. Moshirfar coauthored a paper that described “a marked increase in dry eye symptoms among regular mask users at multiple local clinics.” 4 Several other papers have been published in the literature discussing a connection between mask use and dry eye symptoms. A case report published online drew attention to the issue, calling upon ophthalmologists to “ensure patients are not put at risk of unintended ocular surface exposure leading to secondary infection by addressing inadeµuately fitted facemasks in the immediate post-operative period.” 5 A self-reported survey of more than 3,600 individuals found 18.3% experienced mask-associated dry eye. 6 This survey looked at whether glasses or contacts inyuenced mask- associated dry eye, among other factorsÆ it did not find a significant impact on mask- associated dry eye based on refractive correction type. Dr. Moshirfar said that when his team looked at a survey of patients, they noticed ocular irritation that seemed to be associated with mask use, mostly affecting a certain patient population, those who were elderly, recently had ocular surgery, who had preexisting dry eye, and/or who had lower lid problems. “In certain groups of patients who are at high risk and who might have elevated levels of dryness, epitheliopathy, or already have bad lid excursion or exposure keratopathy, we need to be more aware that if the face mask is not placed properly, their breathing may direct convection of air through their face mask, affecting their tear film. o Ƃs a result, their tear film breaks up sooner and that can, over the course of a few hours, cause more problems,” Dr. Moshirfar said. Dr. Moshirfar noted that many patients who were taping their masks to achieve a better seal to avoid fogging of their glasses actually showed increased dry This article originally appeared in the July 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.