Researchers have linked plenty of eye symptoms with the SARS COV-2 infection — red, itchy, gunky eyes and cornea infections among them — but a growing body of scientific literature is also pointing to societal changes during the COVID-19 pandemic as having significant impact on ocular health.
The sudden move to mostly virtual life in 2020 and the rise in requirements to mask up while interacting in-person are both a focus of a new systematic review produced by researchers from around the world, including the University of Colorado Department of Ophthalmology, working with the Tear Film & Ocular Surface Society (TFOS).
“We were looking for information about how quarantine policies affected ocular surface diseases,” says Riaz Qureshi, PhD, assistant professor of ophthalmology and epidemiology in the CU School of Medicine, who worked on the TFOS report ensuring data quality. “How did shifting to remote work for employees and students affect dry eye symptoms? What impact did wearing masks have on eye diseases? We were able to find literature pointing to these topics and more.”
While many restrictions have eased since the peak of the pandemic, researchers say there is still a lot more to learn about the virus and its effect on society.
“It’s been a relatively short period of time since the pandemic started, but studies took off and researchers were looking for associations of all kinds,” Qureshi says. “COVID-19 and its relationship to eyes was one area where there was actually a substantial amount of literature outside of the direct infectious risk.”
Face masks exacerbate dry eye
With the pandemic came a newfound necessity for face masks, which helped reduce spreading the COVID-19 virus from person to person indoors and in crowded areas. As a result, however, more people reported dry eye symptoms and eyelid inflammation.
“Prolonged and consistent face mask wear appeared to induce of exacerbate symptoms and signs of dry eye disease, intolerance to contact lenses, and increase the prevalence of chalazia,” researchers say.
They point to the direction of air flow while breathing while wearing a face mask.
“All of a sudden people were wearing masks, sometimes for many hours at a time,” Qureshi explains. “You’re blowing air up past the top of the mask and that’s drying out the eyes, especially when it isn’t fit correctly.”
Thermal imaging in one study was able to detect the phenomenon, particularly in participants who were wearing a poorly fitted mask.
The prevalence of masks did have positive effects, too, according to researchers.
“In contrast to symptoms of dry eye, allergic ocular symptoms improved with the use of face masks, most likely due the barrier properties of face masks against nasal exposure to airborne allergens,” researchers say.
More screen time, more eye strain
Telecommuting hit an all-time high during the peak of the pandemic in an effort to curb spread of the disease. Researchers say it also led to more reports of eye strain and other ocular surface symptoms, such as “digital eye strain or computer vision syndrome symptoms, and dry eye symptoms and signs.”
In April, the U.S. Bureau of Labor Statistics reported that about 7.7% of American workers are still telecommuting because of the pandemic. That number is down significantly from May 2020, when the agency first started collecting such data. Then, more than one-third of employed people said they were solely working from home.
“Moving people to remote had a pretty big effect,” Qureshi says. “Having people work from home and being indoors more put people in front of their computers for six or more hours a day. Students in particular, were watching lectures and looking at a screen instead of looking at the front of a class or conference room.”
Some workers reported their screen time increased as much as 40% during their time spent telecommuting.
“If we ever find ourselves in a similar situation in the future, or are continuing to work from home, it might be helpful to remember to look up from your screen every so often,” Qureshi continues. “That helps with the eye strain.”
Researchers also recommend blinking more, optimizing the work environment, and encouraging regular breaks. However, current evidence does not suggest that blue-light blocking interventions, such as glasses or screens, appear to be an effective solution.
Perils of unemployment
The economic downturn that accompanied pandemic-related regulations is another hot spot for eye health, according to researchers.
“Unemployment and retirement have been linked to various health problems including dry eye disease. This might be explained by the higher rate of ocular surface disease risk factors among unemployed individuals,” researchers say. “For example, obesity, smoking, alcohol consumption, and depression are more common among unemployed individuals. Over the past (three) years, the COVID-19 pandemic has impacted the global economy, including causing a rise in unemployment and related health problems.”
Some government estimates put the unemployment rate in May 2020 as high as 16%, substantially greater than that of the Great Recession, from 2007 to 2009.
Researchers say more focus on the impact of employment status and ocular surface health is needed.
They also expect to see more data and studies on eye health and the lasting effects of the pandemic in the future.
“There’s going to be a lot more literature that comes out about long-term impacts of isolation and the policies that played an important role in public health,” Qureshi says. “With eye health and studying time spent in front of screens, for example, it’s unclear what long-term development effects may arise, but we can definitely say we saw some short term social effects.”