What Is Mask-Associated Dry Eye?

This might be why your eyes have been red and scratchy.

Wearing a face mask is an important part of preventing the spread of COVID-19. However, masks can come with some not-so-great side effects like maskne, foggy glasses, and general irritation around your face. Another side effect to look out for is mask-associated dry eye, also known as MADE.

A report published in the July 2020 issue of the journal Ophthalmology and Therapy detailed how there was an increase in cases of eye irritation and dry eye among people who had been regularly wearing masks. The report's authors, who are researchers at the University of Utah, noted that they had seen "a marked increase in dry eye symptoms among regular mask users at multiple local clinics."

The patients in that study included people who have never struggled with dry eye in the past, the researchers pointed out, and those who used masks regularly for longer periods seemed to be more likely to develop symptoms.

Additionally, the Centre for Ocular Research & Education (CORE) also issued an alert to practitioners in August 2020 warning of mask-associated dry eye, along with information on how to relieve the condition.

The University of Utah researchers further noted that their findings would have "important implications on eye health and infection prevention, as mask use is likely to continue for the foreseeable future." Fortunately, you can do something about mask-associated dry eye: Here's what you need to know.

What Is Dry Eye?

Dry eye is a condition that happens when the amount or quality of your tears isn't sufficient, per the National Eye Institute (NEI). This can happen if there's a problem with any of the components of your tear film, which is made up of several layers.

Dry eye is common—the NEI says millions of Americans have to deal with the condition—and it can cause unpleasant symptoms, including:

  • A scratchy feeling, like there's something in your eye
  • Stinging or burning feelings in your eye
  • Red eyes
  • Sensitivity to light
  • Blurry vision

The condition can be caused by a slew of different things: taking certain medications; having laser eye surgery; being exposed to windy, smoky, or dry environments; and looking at screens for too long, the NEI says.

How Can a Face Mask Cause Dry Eye?

The research regarding mask-associated dry eye is ongoing—but there are some theories.

This mask-induced dry eye could be caused by an airflow issue, as noted by the authors of a March 2022 International Archives of Integrated Medicine article. When you breathe out and your mask doesn't have a tight fit, air can flow up and across the surface of your eyes. That encourages evaporation and can ultimately dry out your eyes. (It's similar to how having your AC vents blow directly into your eyeballs can dry them out.)

The Ophthalmology and Therapy report's authors also noted that people who use taped masks for a better seal had eye issues. They guessed that the tape itself could interfere with the lower eyelid's normal functioning, leading to dry eye.

An improper mask fit can even interfere with your eyelids' ability to do their job. "Some doctors have also noted that the masks can pull down the lower eyelids slightly, making it difficult for normal blinking to restore the healthy surface of the eye," Aditya Kanesa-thasan, MD, a corneal specialist at Wills Eye Hospital, told Health.

How To Prevent or Treat Mask-Associated Dry Eye

Dry eye can be a painful issue and how concerned about this you should be ultimately "depends on the severity of the symptoms," Vivian Shibayama, OD, an optometrist with UCLA Health, told Health. If you've been wearing masks all day with no issues, you're probably fine. But if you've been struggling with sudden dry eye symptoms and they're disruptive, you probably want to take action—ideally sooner rather than later.

The first step to helping relieve any eye issues you may have is to ensure your mask fits well, Dr. Shibayama said. Looking for a mask with a nose bridge that you can mold to your face and adjustable ear loops can help ensure a tighter fit.

If that doesn't work, Dr. Kanesa-thasan recommended folding a tissue into a roll and tucking it under the top of the mask to "add an extra cushion to the top edge of the mask and prevent air from escaping, similar to placing a towel under the door to avoid a draft."

You can also try to use medical tape to seal your mask across your nose, Dr. Kanesa-thasan said. "Take care to use the right tape for this to avoid skin irritation, and tape the mask to the cheek instead of the lower eyelid to maintain healthy blinking," Dr. Kanesa-thasan added.

At night, you can use hot compresses on your eyes (wet a washcloth with warm or hot water, and lay it on your eyes for a few minutes). This can help stimulate your eyelid's Meibomian glands—which are responsible for the oily outer layer of your tears—and push more oil out of the glands, Dr. Shibayama said. And, with more oil in your tears, the lubrication on your eyes should be less likely to evaporate as quickly.

Using lubricating eye drops a few times a day may also help, Dr. Shibayama said, adding that "[o]il-based lubricants may be more effective—they help with tear evaporation." However, Dr. Shibayama pointed out that these only work if you don't wear contacts.

If your mask-associated dry eye is severe, wearing sealed goggles, like Ziena's moisture chamber eyecups, may help, Dr. Shibayama said. "If fit properly, it keeps moisture in and the virus out," Dr. Shibayama added. And if you're still struggling, your eye doctor may recommend that you try a fluid-filled gas-permeable contact lens called a scleral lens to encase your eyes in fluid. "This gives the patient more consistent moisture throughout the day and also corrects vision," Dr. Shibayama said.

A Quick Review

If you're a frequent mask wearer and are experiencing symptoms of dry eye for the first time, your mask may be to blame. Try any of the above tips to prevent your eyes from drying out when wearing a mask.

Above all, talk to your eye doctor if you're having issues with mask-associated dry eye. "I want to emphasize the importance of mask wearing, but that doesn't mean you have to be uncomfortable," Dr. Kanesa-thasan said.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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