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The impact of prolonged face mask use on ocular surface health during COVID-19 pandemic: a clinical, and conjunctiva impression cytology study

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Abstract

Purpose

To investigate the relationship between prolonged face mask use and ocular surface health utilizing conjunctival impression cytology, the Schirmer test, the tear break-up time (TBUT) test, and the ocular surface disease index (OSDI) questionnaire.

Methods

In this cross-sectional prospective study, individuals who used face masks for at least eight hours per day for at least six months were compared to healthy volunteers who used face masks for no more than one hour per day. Each participant completed an OSDI questionnaire. The Schirmer test (under anesthesia), the TBUT test, and conjunctiva impression cytology analysis according to the Nelson classification method were performed on each participant.

Results

This study included 102 (49 male, 53 female) face mask users with an average age of 33.29 ± 7.71 years and 110 (60 male, 50 female) healthy controls with an average age of 32.96 ± 7.10 years (p = 0.746). The total OSDI score was significantly higher in face mask users than the control group (25.18 ± 3.54 vs 9.46 ± 2.13, p < 0.001). The mean Schirmer test value and TBUT were significantly lower in the study group than the control group (p < 0.001, p < 0.001). There was a statistically significant difference between the two groups in total score and stage of the Nelson classification system (p < 0.001, and p = 0.024, respectively). All conjunctiva impression cytology assessments, including cellularity, cell–cell contact, nucleus/cytoplasma ratio, goblet cell amount, and metaplasia, revealed statistically significant deterioration in the study group compared to the control group (p < 0.001, p = 0.025, p < 0.001, p < 0.001, and p < 0.001, respectively).

Conclusion

The prolonged use of face masks leads to dry eyes. The findings of conjunctiva impression cytology indicate the role of inflammation in the pathogenesis of mask associated dry eye.

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Funding

Each author declares that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Emek Mah. Namık Kemal Cad. No:54, 34785, Sancaktepe, Istanbul, Turkey

    Sumeyra Koprubasi & Amber Senel Kukner

  2. Department of Pathology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey

    Feyza Basar

Authors
  1. Sumeyra Koprubasi
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  2. Feyza Basar
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  3. Amber Senel Kukner
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SK, FB, and ASK. The first draft of the manuscript was written by SK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sumeyra Koprubasi.

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Koprubasi, S., Basar, F. & Senel Kukner, A. The impact of prolonged face mask use on ocular surface health during COVID-19 pandemic: a clinical, and conjunctiva impression cytology study. Int Ophthalmol 44, 59 (2024). https://doi.org/10.1007/s10792-024-02990-5

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  • DOI: https://doi.org/10.1007/s10792-024-02990-5

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