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Navel V, Labetoulle M, Lazreg S, Brémond-Gignac D, Chiambaretta F. COVID-19 pandemic and impact of universal face mask wear on ocular surface health and risk of infection. J Fr Ophtalmol 2024; 47:104170. [PMID: 38569271 DOI: 10.1016/j.jfo.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.
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Affiliation(s)
- V Navel
- CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - S Lazreg
- Centre d'ophtalmologie Lazreg, Blida, Algeria
| | - D Brémond-Gignac
- Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
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Teo MAL, Sullivan EO, Patel BCK, Malhotra R. Real or MADE-up: Investigating Mask-Associated Dry Eye (MADE) as an emerging syndrome. Eye (Lond) 2024; 38:1091-1096. [PMID: 38191659 PMCID: PMC11009259 DOI: 10.1038/s41433-023-02847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024] Open
Abstract
Mask-Associated Dry Eye (MADE) has emerged as a consequence of widespread face mask usage during the Covid-19 pandemic. This review critically assesses the available evidence. A comprehensive search on PUBMED and EMBASE was conducted to identify studies on MADE, which were then categorized based on their design. A total of 26 studies were critically appraised, with the majority exhibiting poor study design quality. Investigating the impact of mask use on ocular surface irritation faced challenges due to global mask mandates, pandemic-related behavioural changes, and a lack of validated methods to measure the response to mask wear. Among the 15 studies, 12 reported a statistically significant reduction in TBUT associated with mask wear; however, the median decrease of 1.3 s was considered clinically insignificant. Results from Schirmer's test in 8 studies varied, with 5 studies reporting a decrease, contradicting the hypothesis of misdirected airflow. Out of 7 studies on corneal and conjunctival staining, 6 indicated a worsening associated with mask wear. Five studies investigating OSDI scores reported an increase following mask wear, but 3 studies repeated the survey too soon. Limited evidence suggests that masks may cause mild ocular surface irritation, but the quality and certainty of this evidence remain low. Methodological limitations were prevalent across the majority of studies, and the observed changes were minimal. Therefore, it is unlikely that significant ocular surface pathology will develop in the majority of mask wearers. Currently, there is insufficient data to support the establishment of a new syndrome.
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Affiliation(s)
| | | | - Bhupendra C K Patel
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Mohamed-Noriega K, Charles-Cantu DE, Mohamed-Noriega J, Velasco-Sepúlveda BH, Morales-Wong F, Villarreal-Méndez G, Mohamed-Hamsho J. Face Mask and Tear Film Stability: A Pilot Study of the Objective Measurement of Tear Break-Up Time. J Clin Med 2023; 12:7727. [PMID: 38137796 PMCID: PMC10743798 DOI: 10.3390/jcm12247727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/29/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Mask-associated dry eye (MADE) has been associated with increased dry eye symptoms, apparently due to reduced tear break-up time (TBUT). This study aimed to determine the short-term impact of surgical face mask (FM) on tear film stability by measuring non-invasive tear break-up time (NIBUT). (2) Methods: Twenty-six healthy participants had NIBUT evaluated without FM, with surgical FM and with a surgical FM secured to the skin with adhesive tape (TFM). NIBUT-first was measured with Keratograph 5M (K5M, Oculus, Wetzlar, Germany). Each participant had NIBUT measured in four sessions on four consecutive days. Session 1: without FM vs. with FM. Session 2: with FM vs. without FM. Session 3: without FM vs. with TFM. Session 4: with TFM vs. without FM (3). The time between each measured setting was 2 min. Results: The mean ± SD NIBUT without FM was 8.9 ± 3.7, with FM 10.2 ± 4.1, and with TFM 8.4 ± 3.8 s. No significant differences were observed in NIBUT in any of the evaluated settings: without FM vs. with FM (p = 0.247), without FM vs. with TFM (p = 0.915), and with FM vs. with TFM (p = 0.11). (4) Conclusions: This study did not find a significant short-term effect of FM on NIBUT. Other variables or longer periods of exposure might trigger the symptoms and ocular surface alterations in MADE.
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Affiliation(s)
- Karim Mohamed-Noriega
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Avenida Francisco I Madero 3501 y Avenida José Eleuterio González (Gonzalitos) S/N, Colonia Mitras Centro, Monterrey 64460, Nuevo León, Mexico; (D.E.C.-C.); (J.M.-N.); (B.H.V.-S.); (F.M.-W.); (G.V.-M.); (J.M.-H.)
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Lima-Fontes M, Martinho-Dias D, Leuzinger-Dias M, Cunha AM, Neves Cardoso P, Torrão L, Moreira R, Falcão-Reis F, Pinheiro-Costa J. Microbiological Profile of Infectious Keratitis During Covid-19 Pandemic. Clin Ophthalmol 2023; 17:535-543. [PMID: 36798798 PMCID: PMC9926925 DOI: 10.2147/opth.s395877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 02/11/2023] Open
Abstract
Purpose The Covid-19 pandemic introduced significant changes in our daily life, including the widespread use of face masks. The purpose of this study was to assess if significant changes occurred in the microbiological profile of infectious keratitis. Patients and Methods A retrospective study was performed, based on a survey review of the electronic medical records of all patients with presumed infectious keratitis, between March 2020 and October 2021. The microbiological isolates in this sample (pandemic group) were compared with those obtained in our center between 2009 and 2018 (pre-pandemic group). Results A total of 194 samples were included in the pandemic group. We obtained a culture-positivity rate of 43.3%, which was significantly higher when compared with the pre-pandemic data (35.15%, p = 0.033). Several further significant differences were found between the pandemic and the pre-pandemic groups: the proportion of bacteria, including gram-positive and gram-negative groups, was higher in our sample (pre-pandemic vs pandemic: 76.78% vs 83.33%, p = 0.010; 53.35% vs 60.71%, p = 0.016; 23.43% vs 34.52%, p = 0.005, respectively); two populations of Gram-positive bacteria found in this study were not isolated in the pre-pandemic sample - Dolosigranulum pigrum and Propionibacterium spp.; and two bacterial isolates were significantly increased in our sample - Corynebacterium spp. (18.41% vs 29.76%, p = 0.003) and Pseudomonas aeruginosa (9.00% vs 16.66%, p = 0.012). Conclusion In conclusion, significant changes were found in the microbiological profile of infectious keratitis in our center during the Covid-19 pandemic. While these changes could be related to face mask use, more observational and experimental studies are needed to explore this possible association.
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Affiliation(s)
- Mário Lima-Fontes
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal,Correspondence: Mário Lima-Fontes, Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | - Daniel Martinho-Dias
- Department of Community Medicine, Information and Decision in Health, University of Porto Faculty of Medicine, Porto, 4050-313, Portugal,CINTESIS – Center for Health Technology and Services Research, University of Porto, Porto, 4050-313, Portugal,Family Health Unit Ao encontro da Saúde, ACES Santo Tirso-Trofa, Trofa, 4745-559, Portugal
| | - Mariana Leuzinger-Dias
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Pedro Neves Cardoso
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4050-313, Portugal
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Burgos-Blasco B, Arriola-Villalobos P, Fernandez-Vigo JI, Oribio-Quinto C, Ariño-Gutierrez M, Diaz-Valle D, Benitez-del-Castillo JM. Face mask use and effects on the ocular surface health: A comprehensive review. Ocul Surf 2023; 27:56-66. [PMID: 36577463 PMCID: PMC9789923 DOI: 10.1016/j.jtos.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022]
Abstract
In the COVID-19 period, face masks increased exponentially. Several studies suggest that the rise in ocular discomfort symptoms during the pandemic is mostly part of dry eye disease and that these are due to the effect of face masks, resulting in the newly described term MADE, for "mask-associated dry eye". The most commonly proposed mechanism states that wearing a face mask creates an unnatural upward airflow towards the ocular surface during expiration, although the increased temperature, humidity and levels of carbon dioxide of the exhaled air, stress, increased use of video display terminals, as well as changes in the ocular microbiota may contribute. Evidence supports that the use of face masks causes an increase in dry eye disease symptoms, a decreased tear break-up time, corneal epithelial trauma, periocular temperature changes and inflammatory markers secretion. Given that the use of masks may be frequent in some settings in the near future, it is important to establish its effects and consequences on the ocular surface.
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Affiliation(s)
- Barbara Burgos-Blasco
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain.
| | - Pedro Arriola-Villalobos
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain,Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid; Madrid, Spain
| | - Jose Ignacio Fernandez-Vigo
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain
| | - Carlos Oribio-Quinto
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain
| | - Mayte Ariño-Gutierrez
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain
| | - David Diaz-Valle
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain,Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid; Madrid, Spain
| | - Jose Manuel Benitez-del-Castillo
- Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC). Hospital Clinico San Carlos. Madrid. Spain,Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid; Madrid, Spain
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Szkodny D, Wylęgała A, Chlasta-Twardzik E, Wylęgała E. The Ocular Surface Symptoms and Tear Film Parameters during and after COVID-19 Infection. J Clin Med 2022; 11:jcm11226697. [PMID: 36431174 PMCID: PMC9695362 DOI: 10.3390/jcm11226697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to evaluate the ocular surface parameters of post-COVID-19 patients when compared to healthy controls. METHODS Patients after symptomatic SARS-CoV-2 infection, as confirmed by a PCR test of their nasopharyngeal swab sample, were enrolled. Complete ophthalmic examination, including visual acuity test, intraocular pressure measurement (IOP), slit-lamp examination, tear osmolarity test, central corneal thickness, endothelial cell number measurements, non-invasive keratograph break-up time (NIKBUT), meniscus height, and the Schirmer's test were performed and compared with the controls. RESULTS It must be noted that there were 36 COVID-19 patients and 25 control subjects included in the study. Eye itching and burning (19%) were the most common symptoms of COVID-19 infection, followed by a subjective decrease in vision (17%), conjunctivitis and eye pain were present in 11%, and 6% of the patients had episcleritis. The mean time from initial infection was 6.5 ± 3.9 (range 1-24 weeks). Meniscus height was not significantly changed between the COVID-19 (0.34 ± 0.13 mm) group and the control (0.33 ± 0.12 mm, p = 0.88) group. In addition, the NIKBUT-1 (p = 0.88; 7.22 ± 4.60 s and 6.91 ± 4.45 s) and NIKBUT average (p = 0.91, 12.30 ± 5.86 s and 11.77 ± 4.97 s) test results showed no significant change either. Neither was a significant result found in the IOP (p = 0.17, 14.56 ± 2.10 mmHg and 14.11 ± 1.96 mmHg); the Schirmer test (p = 0.18, 20.22 ± 7.92 mm and 20.02 ± 7.17 mm); Tosm (p = 0.16, 294.42 ± 54.51 mOsm/dL and 299.33 ± 5.65 mOsm/dL); CCT (p = 0.06, 549.15 ± 28.98 vs. 539.21 vs. 29.08 µm); nor the endothelial cell density (p = 0.07, 2516.64 ± 287.61 vs. 2454.21 ± 498.60 cells/mm2). CONCLUSIONS Through this study it was not revealed that there were any significant differences between the post-COVID group and control group in the objective measurements of ocular surface conditions, when performed after the acute phase of COVID-19. The exact incidence and mechanism of ocular findings, especially dry eye disease, in correlation with SARS-CoV-2 requires further research.
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Affiliation(s)
- Dominika Szkodny
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland
- Correspondence:
| | - Adam Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
| | | | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland
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Assessment of the Effect of Wearing a Surgical Face Mask on Tear Film in Normal Eye Subjects. J Ophthalmol 2022; 2022:2484997. [PMID: 36017483 PMCID: PMC9398824 DOI: 10.1155/2022/2484997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess the effect of wearing a face mask for a short time on the tear film parameters in normal eye subjects. Methods. Fifty-four normal eye subjects (14 female and 40 male) aged 18–40 years (23.8 ± 4.4 years) were recruited. A standardized patient evaluation of eye dryness was completed first, followed by noninvasive tear break-up time, phenol red thread, and tear ferning tests. A 5-minute gap was allowed between the tests. The subjects were asked to wear a surgical mask for one hour. The measurements were taken both before wearing a face mask and immediately after its removal. Results. Significant (Wilcoxon test) differences were found between the standardized patient evaluation of eye dryness (
) and the noninvasive tear break-up time scores (
) before and after wearing face masks. No significant differences (Wilcoxon test,
) were found between the phenol red thread scores and tear ferning grades before and after wearing face masks. Strong correlations (Spearman’s rank correlation coefficient, r) were found among the standardized patient evaluation of eye dryness score (r = 0.590;
), noninvasive tear break-up time measurements (r = 0.631;
), and the tear ferning grades (r = 0.517;
) before and after wearing the mask. A medium correlation (r = 0.377;
) was found between the noninvasive tear break-up time scores and tear ferning grades before wearing the mask. Conclusions. Wearing a surgical face mask for a short duration of one hour has an effect on ocular tear film in normal eye subjects. Dry eye symptoms and tear break-up increased after wearing a face mask compared with those experienced before wearing one.
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Koshevarova VA, Westenhaver ZK, Schmitz-Brown M, McKinnon BJ, Merkley KH, Gupta PK. Blepharoconjunctivitis and Otolaryngological Disease Trends in the Context of Mask Wearing during the COVID-19 Pandemic. Clin Pract 2022; 12:619-627. [PMID: 36005068 PMCID: PMC9406373 DOI: 10.3390/clinpract12040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Purpose: In 2020, wearing of face masks was mandated in the United States in an effort to lessen transmission of the novel 2019 coronavirus disease (COVID-19) pandemic; however, long-term mask wearing may present with unintended side-effects in both ophthalmic and otolaryngologic clinical practice. This study aims to examine if mask wearing increased the incidence of primarily chalazion, blepharoconjunctivitis, and rhinitis occurrence during the mask-mandated COVID-19 pandemic period. (2) Methods: Medical records from tertiary academic center clinics were analyzed for incidence of ophthalmic and otolaryngologic diagnoses of interest (blepharoconjunctivitis- and rhinitis-related disorders). Data were collected from a pre-pandemic (March 2019–February 2020) and a mid-pandemic window (March 2020–February 2021) during which widespread mask mandates were implemented in Texas. Comparison was performed using a t-test analysis between incidence of chosen diagnoses during the described time periods. (3) Results: Incidence of ophthalmic disorders (primarily blepharoconjunctivitis and chalazion) in the pre-pandemic versus mid-pandemic windows did show a significant difference (p-value of 0.048). Similarly, comparison of otolaryngologic diagnoses (primarily rhinitis and related conditions) between the two time periods showed a significant difference (p-value of 0.044) as well. (4) Conclusion: Incidence of the chosen ophthalmic and otolaryngologic disorders did increase during periods of mask mandates. While these findings are preliminary, further studies are warranted to understand other factors that may have played a role in eye and nose pathology.
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Affiliation(s)
| | - Zack K. Westenhaver
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Mary Schmitz-Brown
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Brian J. McKinnon
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Kevin H. Merkley
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Praveena K. Gupta
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
- Correspondence: ; Tel.: +1-409-747-5823
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Diurnal changes of noninvasive parameters of ocular surface in healthy subjects before and after continuous face mask wearing during the COVID-19 pandemic. Sci Rep 2022; 12:12998. [PMID: 35906320 PMCID: PMC9334741 DOI: 10.1038/s41598-022-17486-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
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.
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The Effect of Face Masks during COVID-19 Pandemic on Ocular Surface Temperature-A Clinical Thermographic Analysis. Diagnostics (Basel) 2022; 12:diagnostics12061431. [PMID: 35741241 PMCID: PMC9221900 DOI: 10.3390/diagnostics12061431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Due to the COVID-19 pandemic, the center for disease control and prevention (CDC) recommends face-mask wearing for all people above the age of two years. The wearing of face masks creates a unique airflow towards the ocular surface which may influence the normal physiological conditions of the ocular and periocular surface. Healthy subjects with no ocular history were enrolled in this cross-sectional study. The Therm-App thermal imaging camera was used for ocular surface temperature (OST) measurements during inspirium and expirium. Five regions of interest (ROIs) were used to measure OST: medial conjunctive, cornea, lateral conjunctive, upper eyelid and entire orbital area. Additional measurements in the same locations were made with the upper margin of the mask taped with micropore surgical tape. Thirty-one patients were included in this study. OST during expirium was significantly higher compared to the temperature during inspirium in all locations measured (p < 0.001, paired samples t-test). The temperature of the upper eyelid was higher by more than 0.5 °C during expirium. Taping the mask’s upper edges to the skin resulted in non-significant temperature changes in inspirium vs. expirium. In conclusion, wearing a face mask creates air flow towards the periocular and ocular surface, which changes the OST mostly on the eyelids.
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Escribano Villafruela J, de Urquía Cobo A, Martín Luengo F, Antón Modrego V, Chamorro González-Cuevas M. Changing trends in ophthalmological emergencies during the COVID-19 pandemic. PLoS One 2022; 17:e0268975. [PMID: 35622877 PMCID: PMC9140243 DOI: 10.1371/journal.pone.0268975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
On March 11, 2020, the World Health Organization declared COVID-19—the infectious disease caused by SARS-CoV-2—a pandemic. Since then, the majority of countries—including Spain—have imposed strict restrictions in order to stop the spread of the virus and the collapse of the health systems. People’s health care–seeking behavior has exhibited a change, not only in those months when the COVID-19 control measures were strictest, but also in the months that followed. We aimed to examine how the trends in ophthalmological emergencies changed during the COVID-19 pandemic in one of the largest tertiary referral hospitals in Spain. To this end, data from all the patients that attended the ophthalmological emergency department during the pandemic period—March 2020 to February 2021—were retrospectively collected and compared with data from the previous year. Moreover, a comparison between April 2020—when the restrictions were most severe—and April 2019 was made. A total of 90,694 patients were included. As expected, there was a decrease in the number of consultations. There was also a decrease in the frequency of conjunctival pathology consultations. These changes may bring to light not only the use that people make of the emergency department, but also the new trends in ophthalmological conditions derived from the hygienic habits that the COVID-19 pandemic has established.
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Affiliation(s)
| | - Antonio de Urquía Cobo
- Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fátima Martín Luengo
- Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Víctor Antón Modrego
- Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Yeoh CB, Seier KP, Francis J, Abramson DH, Tan KS, Tollinche LE. Perioperative corneal injury: An unseen casualty of COVID-19. JOJ OPHTHALMOLOGY 2022; 9:555757. [PMID: 36092687 PMCID: PMC9455800 DOI: 10.19080/jojo.2022.09.555757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study is the first to reveal an increased incidence in perioperative corneal injuries during the COVID era and should alert clinicians to this observation. This study could inform investigations into practice or patient factors that changed as a result of the COVID pandemic. We were aware of several adverse corneal injury reports during COVID and as a result did a formal IRB approved retrospective review to see if corneal injuries were more common during that period. METHODS This is a retrospective cross-sectional observational study based on the hospital reporting of corneal injuries in the peri-operative time-period during the COVID pandemic. Comparison to known incidence of corneal injuries from the same institution in the pre COVID era were made. The objective was to examine if there were increased peri-operative corneal injuries during the COVID pandemic compared to other time points at our institution. RESULTS All corneal injury event reports were aggregated for the time period including January 1, 2015 through April 30, 2021. Data include all patients who underwent anesthesia for any procedure at all sites within the hospital system. Corneal injury rates (in lieu of total number of events) were utilized to account for variation in perioperative volume. Using Poisson regression, corneal injury rates were significantly higher after March 2020 compared to the other time points. Alternatively, RISQ reporting rates were significantly lower after March 2020 compared to other time points. CONCLUSIONS This study reveals an increased incidence in perioperative corneal injuries during the COVID era and should alert clinicians to this observation. This study may inform investigations and may ultimately drive processes that could mitigate preventable causes of perioperative corneal injury.
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Affiliation(s)
- Cindy B Yeoh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center
| | - Kenneth P Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Jasmine Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - David H Abramson
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Luis E Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center
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Impact of prolonged face mask wearing on tear break-up time and dry eye symptoms in health care professionals. Int Ophthalmol 2022; 42:2141-2144. [PMID: 35119609 PMCID: PMC8815392 DOI: 10.1007/s10792-022-02213-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the impact of prolonged surgical face mask wearing on dry eye symptoms and tear film break-up time (T-BUT) in health care professionals. Materials and methods A total of 33 health care professionals were included in the present cross sectional prospective study. In addition to a complete ophthalmological examination T-BUT measurements were performed twice for all participants in the morning (8 am) and in the afternoon (5 pm). The subjects also filled-in the ocular surface disease index (OSDI) questionnaire twice, before and after wearing the face mask, on the same day. Results Sixty-six eyes of 33 participants (17 female and 16 male) were evaluated. The mean age was 33.6 ± 7.55 (24–48) years and mean total duration with mask on between the two evaluations was 514 ± 12.5 (495–526) minutes. The mean T-BUT was 9.3 ± 1.0 (3–16) seconds at 8 am and 8.3 ± 1.5 (3–14) seconds at 5 pm (p = 0.01). The mean OSDI score was 20.1 ± 8.3 (0–68.75) at 8 am and 27.4 ± 10.4 (0–81.25) at 5 pm (p < 0.01). Conclusion Use of a surgical mask for the entire work-day was seen to worsen T-BUT and increase dry eye symptoms in healthy individuals. Ophthalmologists should be aware of the possibility of worsening of dry eye symptoms with the prolonged use of surgical face masks and consider modifications if necessary.
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Unmasking People’s Opinions behind Mask-Wearing during COVID-19 Pandemic—A Twitter Stance Analysis. Symmetry (Basel) 2021. [DOI: 10.3390/sym13111995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Wearing a mask by the general public has been a controversial issue from the beginning of the COVID-19 pandemic as the public authorities have had mixed messages, either advising people not to wear masks if uninfected, to wear as a protective measure, to wear them only when inside a building/room with insufficient air flow or to wear them in all the public places. To date, the governments have had different policies regarding mask-wearing by the general public depending on the COVID-19 pandemic evolution. In this context, the paper analyzes the general public’s opinion regarding mask-wearing for the one-year period starting from 9 January 2020, when the first tweet regarding mask-wearing in the COVID-19 context has been posted. Classical machine learning and deep learning algorithms have been considered in analyzing the 8,795,633 tweets extracted. A random sample of 29,613 tweets has been extracted and annotated. The tweets containing news and information related to mask-wearing have been included in the neutral category, while the ones containing people’s opinions (for or against) have been marked using a symmetrical approach into in favor and against categories. Based on the analysis, it has been determined that most of the mask tweets are in the area of in favor or neutral, while a smaller percentage of tweets and retweets are in the against category. The evolution of the opinions expressed through tweets can be further monitored for extracting the public perspective on mask-wearing in times of COVID-19.
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Cutaneous Anaplastic Large Cell Lymphoma: A Case Report about Masking Effect of Facial Masks in the COVID-19 Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3783. [PMID: 34422530 PMCID: PMC8376388 DOI: 10.1097/gox.0000000000003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 global pandemic commenced widespread usage of face masks. Due to covering of the lower face in public settings, limited social interaction, and patient hesitancy for seeking in-person healthcare, dermatologic conditions of the lower face are prone to delayed diagnosis and management. With society recovering from the pandemic and social distancing restrictions being lifted, an increasing number of patients present with malignant skin conditions at advanced stage. The authors describe a 47-year-old female patient who presented with a 4-month-old facial mass that was initially believed to originate from skin irritation caused by mask-wearing. A biopsy revealed primary cutaneous anaplastic large cell lymphoma (PC-ALCL). This case report outlines the management of the rare PC-ALCL lesion and diagnostic challenges related to facial masks and social distancing.
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