Eyeworld

104 | EYEWORLD | JULY 2021 C ORNEA Contact Moshirfar: cornea2020@me.com Silkiss: rsilkiss@aol.com by Liz Hillman Editorial Co-Director About the physicians Majid Moshirfar, MD, FACS Adjunct Professor of Ophthalmology John A. Moran Eye Center Department of Ophthalmology and Visual Sciences University of Utah School of Medicine Salt Lake City, Utah Rona Silkiss, MD, FACS Chief Division of Ophthalmic Plastic, Reconstructive and Orbital Surgery California Pacific Medical Center San Francisco, California widespread mask wear. 3 The retrospective mul- ticenter study evaluated EMR data from a San Francisco community and Los Angeles academic practice from June–August 2020 compared to the same months in 2016, 2017, 2018, and 2019. There was a statistically significant rise in chalazion incidence in 2020 when mask wear- ing was prevalent. "It will be interesting to see if the rise in chalazion incidence declines as the incidence of COVID-19 declines and vaccinated individuals are able to curtail their mask wear," Dr. Silkiss said. Dr. Moshirfar coauthored a paper that de- scribed "a marked increase in dry eye symptoms among regular mask users at multiple local clinics." 4 Several other papers have been published in the literature discussing a connection be- tween mask use and dry eye symptoms. A case report published online drew attention to the issue, calling upon ophthalmologists to "ensure patients are not put at risk of unintended ocular surface exposure leading to secondary infection by addressing inadequately fitted facemasks in the immediate post-operative period." 5 A self-reported survey of more than 3,600 individ- uals found 18.3% experienced mask-associated dry eye. 6 This survey looked at whether glasses or contacts influenced mask-associated dry eye, among other factors; it did not find a significant impact on mask-associated dry eye based on refractive correction type. Dr. Moshirfar said that when his team looked at a survey of patients, they noticed oc- ular irritation that seemed to be associated with mask use, mostly affecting a certain patient population, those who were elderly, recently had ocular surgery, who had preexisting dry eye, and/or who had lower lid problems. "In certain groups of patients who are at high risk and who might have elevated levels of dryness, epitheliopathy, or already have bad lid excursion or exposure keratopathy, we need to be more aware that if the face mask is not placed properly, their breathing may direct Mask use associated with dry eye in certain patient populations M asks use quickly became a main- stay during the COVID-19 pandem- ic. While in recent months, mask use has been relaxed somewhat as health guidelines are updated to reflect increased vaccination status and declin- ing case numbers, there are still situations and circumstances where mask wear continues. These face coverings have been credited with playing a role in saving lives, but they have been associated with some unintended ocular consequences as well. The CDC updated its mask guidelines in May 2021 for fully vaccinated individuals. According to the CDC, fully vaccinated people "can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance." 1 As of the time of publication, the CDC still recommends unvacci- nated individuals "wear masks in public set- tings, at events and gatherings, and anywhere they will be around other people." 2 Majid Moshirfar, MD, and Rona Silkiss, MD, who both published papers observing ocular conditions associated with mask use, empha- sized the importance of mask wearing. Dr. Silkiss' publication demonstrated an increased incidence of chalazion following Tips to mitigate mask- associated dry eye Be aware of risk factors (elderly, recent ocular surgery, on drops with preservatives, existing dry eye, lid problems, etc.) Ensure proper fit and placement of masks. Use additional moisturizing artificial tears throughout the day. Take breaks to close eyes for several minutes at a time. Perform blinking exercises.

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