Dry Eye symptoms during the COVID-19 era

ABSTRACT

Purpose: Preliminary evidences from the literature, together with our everyday clinical practice and patients reporting, led us to hypothesize that dry eye (DED) symptoms related to some COVID-19 mitigation measures might be a common problem and a relevant issue. We designed this study in order to assess and to monitor DED symptoms' changes from 2019 to 2021, in both DED patients and healthy subjects, and to investigate their relationship with homeworking and facemask wearing. Methods: We retrospectively reviewed the medical records of patients who, between November and December 2019 (V19), had undergone an eye exam including quantification of Ocular Surface Disease Index (OSDI) score at the Eye Clinic San Giuseppe Hospital, Milan. Between November and December 2020, we performed a telephone survey (V20) contacting these patients. The survey was repeated between November and December 2021 (V21). The telephone survey included the OSDI 12-items and a custom-made questionnaire exploring type of job or occupation, home working, screen time, type and average time of face mask-wearing, and recent onset and worsening of DED-related symptoms. We investigated the difference among V21, V20 and V19 DED symptoms, the rate of subjects with OSDI increase > OSDI minimal clinically important difference (MCID), and associations between DED symptoms, face masks wearing, VDT usage and home working. Results: Of 120 subjects with V19 OSDI≤12, 43 (36%) and 39 (32%) showed OSDI>12 at V20 and at V21, respectively. OSDI was significantly correlated with duration of face masks use (V20 r= 0.29;P<0.01. V21 r= 0.23;P<0.01) and heavy mask users had a significantly higher OSDI (P<0.05). V20 and V21 OSDI was significantly higher in home-workers (P<0.05) but we did not find a significant correlation between V21 OSDI and referred number of VDT use (r= 0.07;P=0.41). Of 70 patients with V19 OSDI>12, 18 (26%) and 24 (34%) showed symptoms worsening >MCID at V20 and V21, respectively. The percentage of OSDI worsening >MCID was significantly higher among heavy face masks users (73% vs 12%;P<0.01, Fisher test). The percentage of OSDI worsening >MCID was significantly higher in home workers at V20 but not at V21. Conclusions: Some COVID-19 mitigation strategies seem to have a significant role in triggering DED symptoms onset or worsening. This issue persisted during the second pandemic year, with weaker correlation to presumed trigger factors.