Diurnal changes of noninvasive parameters of ocular surface in healthy subjects before and after continuous face mask wearing during the COVID-19 pandemic

Abstract

To investigate whether diurnal changes in noninvasive ocular surface parameters and subjective symptoms occur in healthy subjects wearing face mask who were analyzed before and after 8 h of continuous use. In this prospective cross-sectional study, healthy volunteers attending the same workplace environment underwent a noninvasive ocular surface workup by means of Keratograph 5 M (Oculus, Wetzlar, Germany) in the same day at 2 different time points: (i) in the early morning before wearing face mask (T0); (ii) after 8 h of continuous face mask use (T1). Noninvasive break-up time (NIBUT), tear meniscus height (TMH), ocular redness and meibomian gland dropout were measured. All subjects were asked to complete the Ocular Surface Disease Index (OSDI) questionnaire before and after 8 h of face mask wearing. Data from 20 healthy subjects (10 males and 10 females, mean age 25.1 ± 3.9 years) were included. Mean value of TMH decreased significantly from 0.29 ± 0.07 at T0 to 0.23 ± 0.07 mm at T1 (P < 0.001); conversely, mean values of NIBUT, redness score and meibomian gland dropout did not change significantly after continuous face mask wearing (always P > 0.532). Concerning ocular discomfort symptoms, mean value of OSDI score worsened significantly at T1 compared to T0 (from 12.9 ± 12.6 to 19.4 ± 12.0; P = 0.017). Continuous face mask wearing for 8 h led to decreased TMH associated with the onset of ocular discomfort symptoms in young healthy subjects.

The effects of Facial Mask Use on Ocular Surface Parameters and Tear Film Cytokine Profile in Prolonged Use

“…The results showed that TMH scores decreased after wearing the facial mask. 39 However, depending on the evaporative nature of MADE, the TMH scores were similar in both study groups, as expected. In contrast, in a recent study, the Schirmer strip test scores and TBUT measurements were reported to increase after facial mask wearing by healthcare professionals.…”

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

“…Smaller studies have also reached similar conclusions. For example, Giannaccare et al asked 20 healthy university students to complete the OSDI before and after 8 h of face mask use [ 51 ]. Initial OSDI scores were in the normal range, but worsened significantly after 8 h of continuous face mask use (from 12.9 ± 12.6 to 19.4 ± 12.0; P = 0.014).…”

“…Giannaccare et al [ 51 ] investigated NITBUT, tear meniscus height, ocular redness and infrared meibography using Keratograph 5 M (Oculus, Wetzlar, Germany) before and after 8 h of continuous face mask use in 20 healthy controls. At baseline, mean values of all parameters were within normal range, but on the second examination, mean value of tear meniscus height had decreased around 20%.…”

“…The detrimental effects of face mask may be more limited in the presence of a healthy ocular surface. Some authors have hypothesized that in healthy subjects the tear film homeostatic mechanisms may be capable to counteract the effects of face mask, at least in the short term [ 51 ].…”

Microbiological Profile of Infectious Keratitis During Covid-19 Pandemic

“…[2][3][4][5] The raised awareness for this possible association boosted investigation about this topic and multiple studies were published in 2021 and 2022, reporting significant changes in Ocular Surface Disease Index (OSDI) score and ocular surface parameters, including tear meniscus height, tear film break up time, corneal fluorescein staining, and Schirmer-I test. [6][7][8] These findings led to the consolidation of a new clinical entity called "mask-associated dry eye" (MADE). 9,10 Since most of the commonly used face masks are not air-tight superiorly, this configuration results in an unnatural airflow towards the eyelids and ocular surface during expiration, which could explain the above mentioned findings.…”