Assessment of dry eye disease in N95 versus surgical face mask wearers during COVID-19

Abstract

Purpose: Investigating the effect of different face masks on dry eye disease (DED) among healthcare workers during the COVID-19 pandemic. Methods: This was a comparative, cross-sectional study. Participants were included into two groups: group 1 (n = 30) wore surgical masks, and group 2 (n = 30) wore N95 masks with face shields. Demographic and ocular surface disease index questionnaires (OSDI) were performed. In addition, Tear break-up time (TBUT), corneal and conjunctival fluorescein staining, and meibography to assess meibomian gland loss (MGL) were performed on all participants. Independent T-test was used to compare continuous parameters and Chi-square test for categorical variables. The relationship between continuous variables was tested using bivariate Pearson correlation. Results: Sixty healthcare workers participated in this study (36 females and 24 males). The mean (±SD) age of the surgical mask and N95 groups was 35.33 (±14.94) and 36.63 (±10.64) years, respectively. Both masks caused dryness according to TBUT, MGL, and OSDI scores. DED per DEWS II definition was observed in 14 (46.7%) and 16 (53.3%) patients in groups 1 and 2, respectively. Comparing the two groups, N95 mask caused significantly more dryness according to TBUT ( P = 0.042) and fluorescein staining ( P = 0.038 for the right eye and P = 0.015 for the left eye). Conclusion: Physicians should be aware of the potential dry eye signs secondary to face mask wear during the COVID-19 pandemic. Further attention should be taken in patients who suffer from preexisting dry eye syndrome and in patients who undergo intraocular operations.

Face Mask in COVID-19 and Its Association With Dry Eye Disease: A Cross-Sectional Study

“…Whereas in another study, the OSDI score was higher for female participants in comparison to male participants [ 23 ]. In a similar study on HCWs, no significant differences were observed in DED between genders [ 24 ]. The OSDI values showed a significant difference between age groups, with the age group <40 years having a high median value.…”

“…The OSDI score was highest (67.24) in 53 participants wearing N95 masks without respirators, compared to 48.29 in 54 participants wearing surgical masks in our study. In a cross-sectional study on HCWs for assessment of DED in N95 versus surgical FM wearers during COVID‑19, authors observed a significant increase in the OSDI score in the N95 mask group versus the surgical mask group [ 24 ]. But if we look into the theory proposed, it is surprising as N-95 FM is more air-sealed, so the chances of air skipping must be less as compared to surgical or other masks.…”

“…Participants were divided into two groups based on gender, based on age (younger than 40 years and 40-60 years), duration of wearing FM (<3 hours, three to six hours, and >6 hours per day), and prior DED history. Following survey completion, the OSDI index was calculated using the formula OSDI = (sum of scores) × 25/(number of questions answered), and the severity of DED was graded as mild , moderate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and severe (>33) [20].…”

Face mask use and effects on the ocular surface health: A comprehensive review

“…When the effect of different types of masks on the ocular surface were compared, Azzam et al found that N95 masks caused significantly more dryness according to decreasing TBUT and fluorescein staining [ 53 ].…”

abc

“…Face masks induce dry eye occurs due to blowing of the air upwards when breathing out and due to the limited movement of the lower eyelid which accelerates the evaporation of the tears and leads to the onset or the worsening of the symptoms related to the dry eye disease. [10][11][12] The direct airflow from exhaled air will certainly leads towards the instability, enhanced evaporation and hyperosmolarity which leads towards a decline in the turn over of the tears which ultimately leads towards drying of cornea due to face mask. [13][14][15][16] Severity in the symptoms of mask induced ocular dryness are correlated to the thickness of the lipid layer of the tear film.…”