Investigating the Impact of COVID-19 Infection on Dry Eye Parameters.

PURPOSE: This study aims to compare dry eye parameters before and after COVID-19 infection in dry eye patients. METHODS: We included 44 dry eye patients (88 eyes) from our existing dry eye cohort, with 22 belonging to the post-COVID-19 group due to a prior COVID-19 infection and the other 22 forming the non-COVID-19 group as they had no history of COVID-19. We examined and compared the dry eye parameters of the post-COVID-19 group, including the ocular surface disease index (OSDI), Schirmer's test results (ST), non-invasive Keratography tear break-up time (NIKBUT), lipid layer thickness (LLT), Meibomian gland dysfunction (MGD), and the grading of papillae and follicles, both before and after the COVID-19 infection. We also compared the dry eye parameters difference of the post-COVID-19 group with the non-COVID-19 group. RESULTS: The post-COVID-19 group was comprised of individuals with an average age of 38.36 ± 14.99 years, of which 82% were female. The time interval between the two tests was 16.92 ± 5.40 months, which did not differ significantly from the non-COVID-19 group. Compared to the pre-COVID-19 eyes, the post-COVID-19 eyes showed a significant decrease in the average LLT (52.86 ± 18.00 nm vs. 63.00 ± 22.40 nm, p < 0.001), as well as the maximum LLT (67.89 ± 20.81 nm vs. 78.48 ± 20.55 nm, p < 0.001). The MGD in both the upper (1.75 ± 0.84) and lower eyelids (1.43 ± 0.73) worsened after a COVID-19 infection. Additionally, the grading of papillae was worse following a COVID-19 infection (0.61 ± 0.69 vs. 0.16 ± 0.37, p < 0.001). The multivariate linear regression model revealed a negative association between COVID-19 infection and NIKBUT-average (ß = -2.98, 95%CI: (-5.82, -0.15), p = 0.039), LLT-average (ß = -14.12, 95%CI: (-22.66, -5.59), p = 0.001), and LLT max (ß = -15.65, 95%CI: (-23.09, -8.20), p < 0.001). CONCLUSION: From preliminary results, we concluded that dry eye patients who have been infected with COVID-19 appear to have a more severe dry eye condition, as evidenced by lower LLT, worse papillae and MGD, and shorter NIKBUT. It is important to raise awareness of this potential long-term symptom of COVID-19, especially among existing dry eye patients.

The effect of day-long mask wearing on non-invasive break-up time.

PURPOSE: This study aimed to investigate the effect of day-long face mask wearing on non-invasive tear break-up time (NI-BUT) in health care staff due to working schedules. METHODS: Seventy-four right eyes of 74 participants were included in the study. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire, and NI-BUT measurements were performed between 08.30-09.00 and 16.30-17.00 h. Participants with an initial NI-BUT measurement below 17 s were classified as group-1, and those over 17 s were classified as group-2. NI-BUT changes during the day and correlation to age, gender, and OSDI results were evaluated. RESULTS: Thirty-eight women and 36 men, with a mean age of 30.9 ± 8.5 years, were included in the study. The mean OSDI score of the participants was 28.6 ± 17.1. NI-BUT means of group-1 at baseline and 8th hour were 11.4 ± 3.3 and 7.9 ± 3.6 s, respectively, and the mean NI-BUT at the 8th hour was statistically significantly lower than the baseline (p < 0.0001). Also, 24.2% (8 people) of those in group-2 had the 8th-hour NI-BUT value fallen into the measurable range (below 17 s). No significant correlation was found between the decrease in NI-BUT value and age, gender, and OSDI (p = 0.08, p = 0.3, and p = 0.2, respectively). CONCLUSION: The use of face masks throughout the day leads to a significant reduction in NI-BUT, regardless of age, gender, and OSDI score. Prolonged use of face masks should be considered as a risk factor for evaporative dry eye disease.

Face-Mask Associated Dry Eye (F-MADE) Symptoms and Ocular Surface Alterations

Purpose : Since the onset of the coronavirus disease 19 (COVID-19) pandemic, people's lives have adapted, with the use of face masks becoming a part of our daily routine. Despite being a useful device to prevent disease contagion, a marked increase in dry eye and stye symptoms has been detected. We aimed to perform an observational correlation analysis between face-mask use and to report both objective and subjective ocular surface measurements performed on a multi-purpose advanced corneal topographer and a high-definition camera. Methods : This study included 25 healthy subjects without any ocular diseases, ages ranging from 19 to 68 years. We measured tear meniscus height, Non-Invasive Tear Breakup Time (NIBUT), overall redness score, and tear film lipid layer characterization using Keratograph 5M (Oculus, Wetzlar, Germany), as well as Ocular Surface Disease Index (OSDI) scores for dry eye symptomatic assessments. Patients were asked the number of hours of mask-use at the moment of enrollment, the average hours of mask use daily, and the type of face mask used. We assessed for differences between OSDI scores and gender and type of mask used, as well as correlation coefficients for all subjective and objective measurements. Results : The mean age of the subjects was 42.44±14.49 years. OSDI scores had no significant differences according to gender (p = 0.1664) or type of mask used (p = 0.0791). Correlation between hours of mask use at the time of testing and ocular surface modifications were minimal. Hours of mask-use at the time of the test and OSDI scores were moderately correlated (r= 0.5047, p=0.01). No correlation was found between the average hours of mask use and any ocular surface measurements or OSDI scores. Conclusions : The use of face masks increased subjectively dry eye symptoms. Nevertheless, ocular surface objective measurements remain unchanged by maskwearing.

Reduction of mask-associated dry eye by using surgical tape to secure the top edge of the mask

Purpose : During the COVID-19 pandemic, mask-associated dry eye (MADE) has increased worldwide possibly because the breath leaks from the top of the masks changes the ocular surface conditions. We tested the hypothesis that surgical taping of the top edge of the mask to the skin reduces the risk of ocular surface damage. Methods : We enrolled 60 volunteers (30 females, 30 males;mean age, 27.1±5.2 years) who wear face masks over 5 hours a day. We measured the fluorescein tear break-up time (FBUT), ocular surface temperature, and conjunctival blood flow before wearing masks, after wearing masks taped on the top edge, and after wearing masks without tape. We used the Ocular Surface Disease Index (OSDI) to record participants' symptoms of MADE and measured their corneal tactile and pain sensitivity using a Cochet-Bonnet esthesiometer. Results : The FBUT with masks without tape (4.4±2.4 seconds) was significantly shorter than that without masks (6.4±3.1 seconds) and with taped masks (5.8±3.2 seconds) (P<0.01 and P=0.05, respectively, Tukey HSD test). There was no significant difference in the FBUT between use of no masks and taped masks (P>0.05). The differences in the corneal and conjunctival temperatures after wearing masks without tape (0.19±0.28 and 0.13±0.28°C, respectively) were significantly higher than after wearing taped masks (0.05±0.27 and 0.06±0.24°C, respectively, P<0.01, paired t-test). The conjunctival blood flow with masks without tape was significantly higher than that of taped masks (P<0.01). Of the 60 subjects, 13 (21.7%) subjects reported MADE symptoms. In the MADE group, the OSDI (P=0.001, analysis of covariance) was significantly higher and the FBUT of masks without tape (P=0.006) was significantly shorter than in the non-MADE group. Pain sensitivity in the MADE group was significantly higher than in the non-MADE group (P<0.01), indicating that subjects in the MADE group were significantly hypersensitive to corneal pain. Conclusions : Wearing masks decreased FBUT and increased ocular surface temperature and blood flow. Taping the top edge of the mask prevented those changes. Fitting masks tightly to the nose or applying tape over the mask may reduce the MADE risk, which can be associated with ocular surface hypersensitivity.

Ocular surface disturbance in patients after acute COVID-19.

BACKGROUND: We investigated the ocular surface disturbances in COVID-19 patients discharged from the hospital. METHODS: One hundred and seventy-nine eyes of 109 healthy participants and 456 eyes of 228 post-COVID-19 patients received comprehensive eye examinations; the latter were interviewed with questionnaires on ocular symptoms before and after COVID-19 diagnosis. Associations of ocular surface manifestations with virological and ophthalmic parameters were evaluated by multivariable mixed linear or logistic regression models. RESULTS: Mean interval between COVID-19 diagnosis and ophthalmic evaluation was 52.23 ± 16.12 days. The severity of meibomian gland dysfunction (MGD) based on clinical staging was higher in post-COVID-19 than healthy eyes (1.14 ± 0.67 vs. 0.92 ± 0.68, p = 0.002) and so was ocular surface staining score (0.60 ± 0.69 vs. 0.49 ± 0.68, p = 0.044). Patients requiring supplementary oxygen during hospitalisation had shorter tear break-up time (ß -1.63, 95% CI -2.61 to -0.65). Cycle threshold (Ct) value from upper respiratory samples (inversely correlated with viral load) at diagnosis had an OR = 0.91 (95% CI 0.84-0.98) with new ocular surface symptoms 4 weeks after diagnosis. The presence of ocular surface symptoms 1 week prior to COVID-19 diagnosis showed an OR of 20.89 (95% CI 6.35-68.66) of persistent or new ocular symptoms 4 weeks afterward. CONCLUSIONS: MGD and ocular surface staining are more common and severe in post-COVID-19 patients. Patients with higher viral loads have greater risks of ocular surface symptoms. Patients requiring supplementary oxygen are more likely to show tear film instability. Ocular surface evaluation should be considered 1-3 months following hospital discharge for any COVID-19 patient.