Table 1.
Pertinent studies assessing ocular surface symptoms with the use of face masks.
| Authors (Country) | Population | Examinations | Observations |
|---|---|---|---|
| Fan et al. (China) | General population (n = 6925) | Online questionnaire | 547 participants had MADE: 419 with new symptoms and 128 participants whose pre-existing dry eye symptoms had worsened with mask wearing. Perceived MADE associated with age, female sex, education, glasses, contact lenses, and pre-existing DED. |
| Boccardo (Italy) | General population (n = 3605) | Online questionnaire | 2447 had symptoms, 658 of which had exacerbated with masks. MADE was present in 18.3% of participants. No association between perceived MADE and age, refractive correction, and pre-existing ocular discomfort. A positive association was observed with female sex and retail work. |
| Al-Dolat et al. (Jordan) | Medical students (n = 1219) | Online questionnaire and OSDI | Symptomatic DED in 71.7%. Wearing a face mask was not associated with symptomatic DED. Female sex, allergy and >6 h looking at screens associated with symptomatic DED. |
| Neti et al. (Thailand) | General population (n = 535) | Online questionnaire | 37% had previous DED. During lockdown, the mean dry-eye symptom score dropped from 81.6 ± 15.9 to 79.8 ± 17.4 (P < 0.001). A negative correlation between age and visual display terminal usage. The female gender and increased visual display terminal usage were independently associated with worsening DED symptoms. |
| Erogul et al. (Turkey) | Health-care professionals (n = 396) | Online questionnaire | Redness (29.3%) was the most frequently encountered ocular surface symptom, followed by burning (15.7%), pain (14.1%), tingling (10.9%), and rash (6.6%). Significant relationship between face mask-wearing duration and ocular pain. |
| Dag et al. (Turkey) | Health-care professionals (n = 333) | Online questionnaire | Self-reported MADE prevalence was 70%. Having at least one DED symptom without a mask and advanced age were determined as possible risk factors for MADE. Examination of 195 participants with self-reported MADE revealed that 30.7% had aqueous-type dryness with ocular surface staining. |
| Giannaccare et al. (Italy) | Medicine students (n = 107) | Questionnaire and OSDI | 10.3% described appearance or worsening of ocular discomfort symptoms, and 19.6% needed tear substitutes daily. Mean OSDI score was 21, and 57% subjects scored ≥15. |
| Tangmonkongvoragul et al. (Thailand) | Medicine students (n = 528) | OSDI, PSS-10 and an interview | Prevalence of DED was 70.8%. Female sex, contact lens wear, and PSS-10 stress scores were significantly higher in the DED group. Contact lens use and PSS-10 score associated with DED severity. |
| Jahanbani-Ardakani et al. (Iran) | Health-care professionals (n = 215, >6 h) and healthy individuals (n = 149; <2 h of face mask use) | OSDI | OSDI scores were 27.20 ± 13.04 in the health-care group and 7.31 ± 3.9 in the control group (p < 0.001) |
| Krolo et al. (Croatia) | General population (n = 203) | OSDI | Group that used masks 3–6 h had significantly higher OSDI scores compared to <3 h (15.3 vs. 8.3). OSDI was significantly greater in prior DED (36.1 vs. 4.2). Participants with prior DED presented greater worsening, regardless of mask wear duration. |
| Shalaby et al. (Egypt) | Healthy subjects (n = 200: 100 surgical mask and 100 N95) | OSDI | OSDI scores were 22.53 ± 9.55 in the surgical mask group and 21.58 ± 9.6 in the N95 mask group, with no significant differences. The daily number of hours spent wearing a facemask correlated strongly with OSDI scores. |
| Bilici et al. (Turkey) | Health-care professionals (n = 74) | OSDI | Mean OSDI score was 28.6 ± 17.1 |
| Aksoy et al. (Turkey) | General population (n = 52) | OSDI at initial admission, after 8 h of face mask use and after 15 days of >8 h daily taped face mask use | There was a significant difference between all examination times in OSDI scores. |
| Al-Namaeh et al. (United States) | General population (n = 40) | OSDI (online) | Prevalence rates of mild, moderate and severe DED were 15%, 77.5%, and 7.5%, respectively. |
| Esen Baris et al. (Turkey) | Healthy health care professionals (n = 33) | OSDI | The mean OSDI score was 20.1 ± 8.3 (0–68.75) at 8 a.m. and 27.4 ± 10.4 (0–81.25) at 5 p.m. (p < 0.01). Use of a surgical mask for the entire work-day increased dry eye symptoms in healthy individuals. |
| Azzam et al. (Israel) | Health-care professionals (surgical masks n = 30 and N95 n = 30) | OSDI | Both masks caused dryness according to OSDI scores. DED was observed in 14 (46.7%) and 16 (53.3%) patients in groups 1 and 2, respectively. |
| Giannaccare et al. (Italy) | University students (n = 20) | OSDI questionnaire before and after 8 h of face mask use | With face masks, mean OSDI score worsened from 12.9 ± 12.6 to 19.4 ± 12.0. |
| D'Souza et al. (India) | Practicing ophthalmologists (n = 17) | OSDI | Significant increase in OSDI scores with face-masks. A significant increase in discomfort scale and vision scale contributed to this. |
| Alanazi et al. (Saudi Arabia) | Healthy subjects (n = 54) and controls (no mask; n = 50) | SPEED questionnaire | Median SPEED scores increased significantly before and after wearing a face mask (0.5 vs 0.1; p = 0.002) |
| Saldanha et al. (United States of America) | DED patients (n = 388) | Online questionnaire | Prevalences: 25% mild DED, 21% moderate DED and 54% severe DED. Reduced work-related efficiency was noted (moderate dry eye: 51%, mild: 39%, and severe: 38%). Respondents with moderate DED were more likely to note worsening symptoms: pain, headache and difficulty concentrating because of eye symptoms. |
| Scalinci et al. (Italy) | DED patients (n = 67) | OSDI | Median OSDI score increased from 2019 (18.75) to 2020 (20.83). |
| Mastropasqua et al. (Italy) | DED patients (n = 66) and healthy subjects (n = 62) | DEQS questionnaire at baseline and after 3 months | After 3 months, DEQS worsened in DED patients with >3 h of face mask use. DEQS significantly correlated with corneal dendritic cell density and HLA-DR at baseline and 3 months. |
MADE: mask-associated dry eye; DED: dry eye disease; OSDI: Ocular Surface Disease Index; PSS-10: Perceived Stress Scale-10; SPEED: Standardized Patient Evaluation of Eye Dryness; DEQS: Dry Eye-Related Quality-of-Life Score.