Is Wearing a Mask Causing Your Dry Eyes?
What to know about the new COVID-19-era problem and how to prevent it
En español | By now, you've no doubt gotten the message: Wearing a face mask in public is crucial for preventing the spread of COVID-19. Those coverings protect us from the respiratory droplets that come our way when an infected person coughs, sneezes or even talks. But those masks can come with an unwelcome side effect: specifically, dry eye.
A paper from researchers at the University of Utah, which appeared in the journal Ophthalmology and Therapy, noted a significant increase in the number of dry eye cases at local clinics among regular mask wearers. This included both people who already had a diagnosis of the condition and were experiencing worsening symptoms, as well as those who had never had a problem with dry eye, who were coming in and complaining of eye irritation. Professionals are calling it mask-associated dry eye (MADE).
According to the study, the finding “has important implications on eye health and infection prevention, as mask use is likely to continue for the foreseeable future."
Dry eye is a common condition that occurs when your tears aren't providing proper lubrication for your eyes. This may be because your eyes aren't producing enough tears or because the quality of the tears your eyes are producing is poor. Nearly 5 million Americans know the symptoms, which can range from annoying to downright uncomfortable, all too well. Part of the unpleasant picture: a scratchy “I've-got-something-in-my-eye” sensation, stinging, burning, blurred vision and redness.
Older people, who are more likely to get dry eye since the eyes’ tear function declines with age, are particularly prone to MADE symptoms, says Thomas Steinemann, M.D., an ophthalmologist affiliated with MetroHealth Medical Center in Cleveland, and clinical spokesperson for the American Academy of Ophthalmology. Also vulnerable, he adds, are “the large number of us working from home these days, doing a zillion Zoom calls and staring at our computer screens all day long.” Indeed, studies show that when focusing on a computer screen, people blink a whopping 66 percent less than they normally do, causing the tears that coat the eyes to evaporate more quickly.
Many suspect that the link between face masks and dry eye has to do with airflow. “When you exhale in a mask that doesn't have a tight fit, air can escape from the top of the mask and flow across the surface of eyes,” says Steinemann. The moving air dries out the tear film, a thin layer of fluid covering the eye's surface. Poorly fitting masks can also cause problems, pulling down the lower eyelids slightly, causing incomplete eyelid closure.
"When you blink, that force of the blink pushes fluid out of our lids and into your tear film, improving the eyes’ surface,” explains Vivian Shibayama, O.D., an optometrist at the UCLA Health Stein Eye Institute. “If you're not completely closing the two lids together when you blink because you have something driving your lower lid down, it can reduce the amount of liquid that is in your eye.”
What's more, says Douglas Marx, M.D., an oculoplastic surgeon at the University of Utah's John A. Moran Eye Center, “When the lower eyelids are pulled down, that very delicate tissue that lines the lower eyelid, the mucosa — which does not like air — can get dried out, leading to irritation and inflammation."
There are ways to prevent dry eye, but abandoning your mask isn't one of them. A little discomfort is a small price to pay for protection against COVID-19. And normal dryness can be treated , or possibly even prevented, with some simple strategies.
Find the right fit
Look for a mask that has a malleable wire integrated along the top edge, which you mold to the bridge of your nose, so the airflow doesn't escape and move upward toward your eyes, says Steinemann. Another way to keep the mask secure: Put a piece of tape on the nose bridge or along the top of the mask. Steinemann suggests paper medical tape, which he says is less irritating to the skin. Shibayama's pick: Breathe Right nasal strips. “They're a little tackier and can keep the mask in place,” she says, “especially if you're wearing it for long hours.” When pressing the top edge of the mask into place, says Marx, don't go higher than the very top of the cheek.
If your dry eye is especially problematic, consider wearing sealed goggles to keep your eyes safe. “We have a few doctors here at the hospital who use moisture shield goggles,” says Shibayama. “They look like regular glasses but have silicone cups behind the lens, which create a shield over the eyes to block air and create a moist environment.” Another option for severe cases of dry eye, says Shibayama: scleral lenses, fluid-filled contact lenses that protect the ocular surface and keep the eyes bathed in fluid throughout the day.
A lot of people may have had dry eye before the pandemic and simply ignored the symptoms, notes Steinemann. “I think that over the past few months, we've ‘unmasked’ a lot of dry eye patients — people who were kind of getting by because their symptoms weren't too bad,” he says. “They may have been symptomatic, but now they're really symptomatic. Don't wait for your eyes to start bugging you before you start taking action.”
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Over-the-counter artificial tears can be an effective way to keep dry eyes lubricated. (If you plan on using them frequently — say, several times a day — look for a preservative-free formula, which is less likely to irritate your eyes, advises Marx.) And don't forget daily hygiene. Before bed, advises Steinemann, moisten a washcloth with warm water and use it to gently massage the eyelid margins to loosen debris and remove any excess oil that might irritate an already dry eye.
Give eyes a break
Follow the 20-20-20 rule: After every 20 minutes spent looking at your computer screen, look at something 20 feet away for 20 seconds. And be sure to blink consciously — and purposefully — while working on the computer,” says Shibayama. Or try this blinking exercise to coat your eyes with fresh tears: Close your eyes, pause two seconds, then open. Close your eyes again, pause two seconds, then tightly squeeze the lids together for two seconds. Repeat every 20 minutes, about 20 times a day.