Increased Dry Eye Risks and COVID-19: How the 2 Conditions Are Connected

Dry eye—a condition in which the eyes don't make enough tears, or enough quality tears—is incredibly common. Millions of people in the US deal with scratchy, stinging, and burning dry eyes each day. However, some of the lifestyle changes that happened due to the pandemic like mask-wearing, working from home, and increased screen time may have contributed to the increased occurrence of dry eyes. Here, eye experts explain what you need to know about the link between COVID-19 and dry eye—and what you can do about it.

For the most part, the totally mundane things you do regularly can cause or contribute to dry eye—wearing contacts, sitting in front of a computer all day, and not getting enough vitamin A or healthy fats in your diet. And now, it seems the COVID-19 pandemic has been linked to the condition as well, based on how the virus has changed our routines.

Dry Eye and COVID-19 Link

First and foremost: It's unlikely that SARS-CoV-2—the virus that causes COVID-19—directly causes dry eye. Dry eye specifically has not been identified as a symptom of the virus, and if you have dry eye without any other symptoms, it's likely not caused by COVID-19. The following are the most common symptoms of COVID-19:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• Loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Eye doctors had figured out well before the pandemic that more screen time equals a higher risk of dry eyes, but the increase in people working from home and staying home, in general, might be able to explain the increase in dry eye cases, Michelle K. Rhee, M.D., associate director of ophthalmology for Mount Sinai at the Elmhurst Hospital Center, tells Health.

Dr. Rhee recently co-authored a research review published in the journal Eye & Contact Lens that looked at all of the available literature on COVID-19 and dry eye, plus a survey of the cornea and dry eye experts throughout the world. The results showed that lifestyle changes, like remote work/school and everyday mask-wearing, seem to impact dry eye.

"When we're doing things visually intensive, we tend not to blink," Dr. Rhee explains. When you're working in front of a computer all day long, and subbing Zoom get-togethers for IRL social events, chances are you're blinking a lot less, and that can cause the eyes to dry out and feel uncomfortable.

Face Masks and Increased Dry Eye Risk

The other lifestyle change that might make your eyes drier: wearing a mask. "When breathing out, the mask can redirect the airflow—especially if there's leakage around the top part—around or over the eye area," Annie Nguyen, M.D., assistant professor of clinical ophthalmology at the Roski Eye Institute at the University of Southern California's Keck School of Medicine, tells Health. "Like sitting in a room with air conditioning, this increased airflow can cause evaporation over the surface of the eye."

Interestingly, some people may actually find that this airflow helps improve dry eye, Dr. Rhee says. But for others, it makes things worse.

"Another thing with masks is that sometimes they can ride up toward the ocular surface and potentially scratch the surface, depending on the facial anatomy," Dr. Rhee adds. So, if you're still wearing a mask that's too big for your face and rides up constantly, to the point that it can graze your eyes, it might actually be irritating your eye enough to cause dryness.

Masks may also contribute to dry eye if they press near the lower eyelid, Dr. Nguyen says. Part of the way your eyes stay moist is that each time you blink, a little bit of oil comes out of the oil glands that line the eyelid and coat the surface of the eye.

One theory about how masks contribute to dryness is that if the mask applies mechanical pressure near the eyelid margin, it may affect the function of these oil glands and inhibit proper oil release, she explains. Masks may also disrupt the blinking mechanism. "Blinking is very important for tear film formation, so if the mask rises too high on your lower eyelid, you may end up with an incomplete blink, which can cause poor tear film distribution as well," Dr. Nguyen says.

Other COVID-19 Impacts

COVID is mostly transmitted via the respiratory system—breathing in virus droplets through the nose or mouth—but the eyes are thought to be a potential entryway for the virus, though uncommon, Dr. Rhee says.

"It's not as frequent, but it can occur if everything lines up: you are exposed to the virus and it's on your hand, then you take your hand and touch your eye. It's difficult for this to happen, but it can happen," Dr. Rhee says. The surface of the eye is covered by a mucus membrane, called the conjunctiva, which technically can be susceptible to the virus.

When the virus enters via the eyes, it can cause inflammation of the mucus membrane, called conjunctivitis. Conjunctivitis causes symptoms including redness, itchiness, a gritty feeling in the eye, and discharge. The irritation can also cause dry eye, Dr. Rhee says.

Conjunctivitis isn't a particularly unique or surprising symptom of COVID-19, though. Many viruses—most notably, adenovirus, which is a group of viruses that causes cold-like symptoms, herpes virus, and others—can affect the conjunctiva, Dr. Nguyen says. Various bacteria can also cause conjunctivitis. Typically, conjunctivitis from COVID (and from any virus or bacteria, for that matter) is more common in children, Dr. Nguyen adds.

This sort of surface inflammation is uncomfortable and inconvenient—it's highly contagious—but not typically something to be worried about. In very rare cases, Dr. Nguyen says COVID has been linked to inflammation that impacts the optic nerve, the nerve behind the eye that sends signals from the retina (lens of the eye) to the brain. "If [inflammation] does affect the nerve, which is rare, it potentially can affect vision," Dr. Nguyen adds.

Treatment

"Mask-wearing is not going away," Dr. Rhee notes. "It may not be as urgent as it was and is still in some places, but it's not going to disappear, so we need to be aware of these issues now." Remote work is also here to stay. So, the best we can do is learn how to mitigate the drying effects of these lifestyle changes.

Here are a few ways to prevent and improve dry eye during the pandemic:

• Use over-the-counter artificial tears or lubricating eye drops.
• Find a mask that fits properly across the top of your nose and doesn't brush against your lower eyelids. Dr. Nguyen also suggests putting a piece of medical tape across your nose to help fix the air leak issue.
• Employ the 20-20-20 rule during screen time, Dr. Nguyen says. "Every 20 minutes, take a 20-second break and look 20 feet down the room. Blink to make sure the tear film is properly distributed across the ocular surface."

When To See a Doctor

If you try all of the dry eye remedies above and don't notice an improvement within a few days, it's a good idea to see an eye care provider, and make sure there's nothing more serious causing your dry eyes, Dr. Nguyen says.

Also worth noting: If you have other symptoms of COVID-19 along with having dry eyes (especially if you know you may have been exposed) you should self-quarantine and call your doctor. The symptoms of COVID-19 can vary a ton, range from very mild to severe, and may appear 2-14 days after exposure.