Ophthalmic complaints in face-mask wearing: prevalence, treatment, and prevention with a potential protective effect against SARS-CoV-2

Frequency and Difficulty in the Usage of Face Shields Among Oral and Maxillofacial Surgeons During the COVID-19 Era: An Online Survey

Aim

During the COVID-19 era, personal protective equipment (PPE) has become a necessary part of surgeons' routines, and face shields are considered an additional barrier to prevent disease transmission via aerosols. This study aimed to evaluate how often oral and maxillofacial surgeons (OMFS) use face shields and the challenges they face while using them.

Methods

An online survey consisting of fourteen questions was distributed to OMFS, and the responses were collected and analyzed using the chi-square test to determine any associations between categorical variables. A P-value of ≤ 0.05 was considered statistically significant.

Results

Out of the 310 OMFS who responded to the survey (181 males, 129 females, 235 residents, 10 fellows, and 65 practitioners), 42.9% (133/310) and 39.4% (122/310) reported using face shields for minor and major surgical procedures, respectively. The majority of the respondents (74.1%, 230/310) reported decreased efficiency while using a face shield. Reasons for non-compliance included vision-related issues, headache, difficulties with disinfection, and ergonomic factors.

Conclusion

Based on the survey results, the regular use of face shields by OMFS was less frequent, and almost three-fourths of the surgeons found it challenging to use due to various reasons. The reduced compliance with face shield usage highlights the need for more ergonomic face shields to improve compliance.

Effects of Face-Mask Use on Dry Eye Disease Evaluated Using Self-Reported Ocular Surface Disease Index Scores: A Cross-Sectional Study on Nurses in Saudi Arabia

BACKGROUND

Wearing face masks has been an essential part of healthcare workers' lives since the coronavirus disease 2019 (COVID-19) pandemic. This study aims to determine the association between prolonged face mask-wearing and dry eye disorder (DED) among female nurses.

METHODS

An online questionnaire-based cross-sectional study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2021 and February 2022. It covered sociodemographic data, conditions associated with ocular irritation, and questions related to mask-wearing duration. The Ocular Surface Disease Index (OSDI) survey was used to measure DED severity. Binary logistic regression analysis was done and Odd's ratios (OR) with 95% confidence intervals (CI) were reported.

RESULTS

A total of 266 female nurses responded to this study. The majority of the sample (71.1%) fell in the normal-mild DED category (OSDI 0-22), while (28.9%) were categorized as the moderate-severe DED category (OSDI >22). We found a significant independent association of dry eye disorder with wearing a mask for >6 hours/day (OR 2.066, 95% CI: 1.083-3.944). Other significant predictors of DED in this study were wearing corrective eyeglasses (OR 2.382, 95% CI: 1.296-4.376) and having rheumatoid arthritis (OR 17.289, 95% CI: 1.794-166.7).

CONCLUSION

Wearing a face mask for > 6 hours/day was significantly associated with moderate to severe DED among female nursing staff. Ophthalmologists should be aware of this adverse effect in order to promote ways to relieve this condition.

Effect of surgical face mask wearing on tear film in women with a high body mass index

PURPOSE

Due to the COVID-19 pandemic, wearing a face mask has become an essential measure to reduce the rate of virus spreading. The aim of the study was to assess the effect of wearing a surgical face mask for a short period on the tear film parameters in subjects with a high body mass index (BMI).

METHODS

Twenty-five females with a high BMI (31.4 ± 5.5 kg/m2) aged 18-35 years (22.7 ± 4.6 years) participated in the study. In addition, a control group consisting of 25 females (23.0 ± 6.7 years) with a high BMI (29.9 ± 4.1 kg/m2) participated in the study in which no mask was worn. The standardized patient evaluation of eye dryness (SPEED) questionnaire was completed first, followed by the phenol red thread (PRT) and tear ferning (TF) tests, before wearing the face mask. The subjects wore the face mask for 1 hour, and the measurements were performed again immediately after its removal. For the control group, the measurements were performed twice with one hour gap.

RESULTS

Significant (Wilcoxon test, p < 0.05) differences were found between the SPEED scores (p = 0.035) and the PRT measurement (p = 0.042), before and after wearing the surgical face mask. The PRT scores have improved after wearing the surgical face mask, while the dry eye symptoms detected by the SPEED questionnaire have increased. On the other hand, no significant (Wilcoxon test, p = 0.201) differences were found between the TF grades before and after wearing a surgical face mask. For the control group, no significant (Wilcoxon test, p > 0.05) differences were found between the two scores from the SPEED questionnaire and the PRT, and TF tests.

CONCLUSIONS

Wearing a surgical face mask for a short duration leads to a change in volume and quality of tears as well as dry eye symptoms in women with a high BMI.

Impact of COVID-19 pandemic on the ocular surface

BACKGROUND

There have been increased reports of dry eyes in the coronavirus disease 2019 (COVID-19) pandemic era.

AIM

To analyze the differences in tear film properties from pre- and post-pandemic of the COVID-19 era.

METHODS

It was a retrospective comparative study. Patients were divided into three groups according to the data of multimodal ocular surface evaluation: (1) Group 1 if it was before Portugal lockdown decision (from August 2019 to March 2020); (2) Group 2 if it was after Portugal lockdown decision but without mask mandate (from April 2020 to October 2020); and (3) Group 3 if it was after Portugal lockdown but with mask mandate in health public highway (from November 2020 to April 2021). The following variables were analyzed: Lipid layer thickness, blink rate, Schirmer test, tear meniscus height, tear osmolarity, non-invasive break-up time, and loss area of the meibomian glands.

RESULTS

The study included 548 eyes of 274 patients, aged 18 years to 89 years, with a mean age of 66.15 ± 13.40 years at the time of multimodal ocular surface evaluation. Compared to group 1: (1) Mean lipid layer thickness was better in group 2 (P = 0.001) and group 3 (P < 0.001); (2) Schirmer test was similar in group 2 (P = 0.576) and better in group 3 (P = 0.002); (3) Tear osmolarity and loss area of the meibomian glands were worse in group 2 (P = 0.031 and P < 0.001, respectively) and in group 3 (both with P < 0.001); (4) Blink rate and tear meniscus height were similar in group 2 (P = 0.821 and P = 0.370, respectively) and worse in group 3 (P < 0.001 and P = 0.038, respectively); and (5) Non-invasive break-up time was worse in group 2 (P = 0.030) and similar in group 3 (P = 0.263).

CONCLUSION

Our study demonstrated that differences existed in tear film properties comparing data from the pre- and post-pandemic of the COVID-19 era.

Assessment of the Effect of Wearing a Surgical Face Mask on Tear Film in Normal Eye Subjects

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 ( $p=0.002$ ) and the noninvasive tear break-up time scores ( $p<0.001$ ) before and after wearing face masks. No significant differences (Wilcoxon test, $p>0.05$ ) 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; $p<0.001$ ), noninvasive tear break-up time measurements (r = 0.631; $p<0.001$ ), and the tear ferning grades (r = 0.517; $p<0.001$ ) before and after wearing the mask. A medium correlation (r = 0.377; $p=0.005$ ) 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.