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Impact on ocular surface health by protective masks during COVID-19

Poster Details

First Author: A. John INDIA

Co Author(s):    R. Shetty   P. Khamar   T. Vaidya   A. Nair   R. Agrawal   S. Sethu     

Abstract Details


The worldwide COVID-19 pandemic has necessitated mask wearing for several hours each day, especially by health care professionals. There have been anecdotal reports of ocular surface discomfort among regular mask wearers possibly due to the breath flow escaping from the upper border of the mask. Hence, the current study investigated the effect of mask wearing for long hours on the ocular surface clinical parameters, tear fluid soluble factors and ocular surface immune cell proportions in subjects.


Narayana Nethralaya, India


Samples were collected from healthy volunteers after written consent and prior approval of the institutional Ethics Committee. OSDI score, Schirmerメs test-1(ST1), Tear Break up time (TBUT), Lipiview and Ocular Scatter Index (OSI) were measured in subjects prior to and during COVID-19 pandemic (minimum 8 hours of mask wear). Tear fluid collected using Schirmerメs strip were used to measure soluble factors (30 ヨ cytokines, chemokines, etc.,) by multiplex ELISA. Ocular surface cells collected using ocular surface wash (sterile saline) were immunophenotyped using fluorochrome-conjugated antibodies specific for leukocytes, neutrophils monocytes, macrophages, Natural killer cells, T cells and B cells by flow cytometry.


A significant increase in OSDI score, ST1 and TBUT were observed during COVID-19 pandemic compared to pre-pandemic samples. Inverse relationships between OSDI and ST1/ TBUT was seen in COVID-19 pandemic but not in pre-pandemic measurements. A significant difference in tear soluble factors (increasedヨIL-1a/b, IL-2, BDNF, NGF, IFNb, LIF, Perforins, RANTES, TSLP; decreased ヨ IL-8, IL-13, HGF, VEGF) was noted in COVID-19 pandemic period samples compared to pre-pandemic. Significantly higher proportions of leukocytes, T cells, Natural killer T cells, and significantly lower proportions of B cells were observed in ocular surface wash samples collected during COVID-19 pandemic compared to pre-pandemic period.


Unique changes in ocular surface clinical metrics have been observed in health care professionals between the pre-pandemic and COVID-19 pandemic period (which includes long period of mask wear). Clinical parameters, tear factors and immune cells profile observed in mask associated ocular surface discomfort is distinctly different from that reported in patients with dry eye disease. This is suggestive of sustained alterations that are deviant from other common ocular surface conditions. This has implications for OPD practice in the cornea clinic and necessitates understanding the root cause of such changes.

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