CORE shares guidance for mask-associated dry eye

The research centre suggests that optometrists ask patients about symptoms and offer advice for alleviating dry eye symptoms when wearing a face mask

face covering
Pexels/Polina Tankilevitch
The Centre for Ocular Research and Education (CORE) has shared advice for eye care professionals to recognise and help support patients experiencing dry-eye symptoms related to wearing a face mask, described as mask-associated dry eye (MADE).

With face masks becoming an essential part of daily life to help reduce the spread of coronavirus (COVID-19), the researchers have noted an increase in reports of dry and uncomfortable eyes. A recent report in Ophthalmology and Therapy has also observed an increase in ocular irritation and dryness among regular mask users.

Aiming to help practitioners address MADE, CORE has put together guidance for supporting patients with increased symptoms of dry eye or irritation.

“Face masks are crucial in the fight against COVID-19, and ECPs are well-positioned to provide patients with advice on appropriate wear in order to maximise eye comfort,” said Dr Lyndon Jones, director of CORE.

Emphasising the importance of the public continuing to wear masks, Dr Jones added: “Responsibly wearing a mask, even when having to contend with eye dryness, is a critical part of overcoming the global pandemic.

“The good news is that we understand MADE and can address it — an opportunity for ECPs to further communicate their knowledge and ongoing value to patients at a time when sound, scientific guidance is needed more than ever.”

While masks reduce the outward spread of air, this air still needs to disperse and with a mask sitting loosely on the face, CORE suggests this can send a stream of air over the surface of the eye. This can then create conditions that accelerate tear film evaporation, leading to dry spots on the ocular surface and discomfort.

CORE suggests this can worsen symptoms of those with pre-existing dry eye disease, as well as affecting a range of patients, from the elderly who might typically have a poorer quality of tear film, to contact lens wearers, or those who wear masks while working for extended periods in air-conditioned settings or while using screens.

Dry eye symptoms might also lead people to rub their eyes for temporary relief, at a time when experts are encouraging the public to touch their face less.

The researchers are recommending that practitioners consider incorporating actions and questions around MADE into their examinations, including routinely asking patients how their eyes feel whilst wearing a mask, and considering the role a face mask might play if there are worsening symptoms in patients with confirmed dry eye disease, or if they report dry and uncomfortable eyes, or variable vision for the first time.

Speaking to OT, Karen Walsh, professional education team leader and clinical scientist at CORE explained that the centre’s key message for optometrists is: “To be proactive in asking about how patients’ eyes feel when wearing their mask and to be able to reassure them that there are a few steps they can take to help alleviate the issue and improve the comfort of their eyes, whilst maintaining mask-wearing in situations where social distancing is difficult.”

CORE has put together tips for patients, including an infographic on MADE. The organisation has also highlighted the necessity for people to seek advice from their optometrist for any new eye-related concern.

“Mask-wearing is crucial to limit the spread of COVID-19 and we want to ensure any symptoms of eye dryness that may arise can be discovered and managed early in patients – rather than risk having them be discouraged from wearing their mask when they should,” Ms Walsh explained.

The advice ranges from ensuring the mask fits well to limit the upward flow of air over the ocular surface, to using lubricating drops and limiting time in drying environments where possible