The “Quarantine Dry Eye”: The Lockdown for Coronavirus Disease 2019 and Its Implications for Ocular Surface Health

Abstract

The pandemic of coronavirus disease 2019 has led many countries of the world to impose a series of containment measures such as lockdowns (mass quarantines), curfews or similar restrictions (eg, stay-at-home orders, or shelter-in-place orders). All these restrictions were established in order to limit spread of COVID-19. Thus, approximately 3.9 billion people worldwide were under lockdown by early April 2020. During this time (home confinement), some solutions have been proposed by experts to improve work and school productivity, including smart working and online school lessons. However, many of the restrictive measures are likely to act as predisposing factors for dry eye disease (DED), directly or related to sick building syndrome (SBS). Herein, we discuss the implications of quarantine measures on eye health, in particular on DED associated with SBS, and introduce some potential preventive strategies for lockdown-related ocular surface disorders. Several risk factors are implicated in their pathogenesis, including environmental changes (eg, air quality) and modifications in personal behaviors (eg, the abuse of digital devices, malnutrition, and sleep/psychiatric disorders). Considering a number of predisposing factors for DED, it is possible to state that patients under lockdown are at risk of ocular surface alterations. Accordingly, the COVID-19 pandemic era is expected to determine an increase in dry eye patients all around the world (a new phenomenon that we propose to name the "quarantine dry eye") in the event that the restrictive measures will be recursively extended over time.

A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic

“…The literature includes a vast number of studies and articles indicating that DED is likely to have been worsened during the COVID-19 pandemic period [ 32 – 36 ]. In addition to the ocular signs and symptoms reported among people contracting the COVID-19 virus, the lifestyle changes associated with social distancing measures and the wearing of masks have implications for ocular health [ 32 – 39 ].…”

Ocular Manifestations of Post-Acute COVID-19 Syndrome, Upper Egypt Early Report

“… 1–3 A new term emerged as a result of lockdown (Quarantine Dry Eye) which was attributed to personal behavior in both developed and developing countries, this necessitates the change in the treatment and follow-up modalities of those patients. 4 …”

“…[1][2][3] A new term emerged as a result of lockdown (Quarantine Dry Eye) which was attributed to personal behavior in both developed and developing countries, this necessitates the change in the treatment and follow-up modalities of those patients. 4 The appearance of ocular manifestations, drive the ophthalmologists to give medications in the form of eye drops, Some of them have antiviral activities and their use could raise confusion to the physicians as they could affect the level of the virus in the conjunctival tears and secretions. 5 The presence of the virus in the conjunctival tears and secretions revealed the possibility of its transmission through ocular secretions and could explain the deaths amongst ophthalmologists.…”

Impact of the COVID-19 Pandemic on Habilitating Residential Communities for Unaccompanied Minors during the First Lockdown in Italy: The Educators’ Relational Perspective

“…Although the pandemic marginally affected minors in terms of the severity of epidemiological manifestations, with 2.1% of incidence and 0.2% of mortality under 18 years of age [ 5 ], the containment measures affected this population. New policies included physical distancing, lockdown, and closure of educational institutes, as well as a stand-by of support programs for youths and all health services except for the ones dedicated to COVID-19 recovery [ 6 ], with psychosocial, economic, and health-related impacts [ 7 , 8 ]. The psychosocial burden of the pandemic is indeed already having critical repercussions on children’s and adolescents’ mental health, with a still-underestimated and partly unknown magnitude [ 9 , 10 ], to such an extent that Cardenas et al [ 11 ] named it a “parallel pandemic”.…”