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It was written by Dr. Diana Nguyen.
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The COVID-19 pandemic has drastically changed our way of living and it’s been over a year since we’ve adjusted to working at home and wearing masks.  These measures are necessary to control and reduce the spread of the virus, but there appears to be an emerging increase of dry eyes as a result.
So, what is exactly causing the increasing rates of pandemic-induced dry eye (PDE)? The main theories are abnormal amounts of digital screen time, diet, distress and airflow (DDDA). These changes in our everyday lives are disturbing the homeostasis of the tear film and this imbalance is fueling dryness.
Common dry eye symptoms that have increased include watery eyes, burning eyes, feeling of grittiness in the eyes and eye fatigue. If you are experiencing one or more of these symptoms, you may have PDE. Let’s go over the various causes of PDE due to abnormal amounts of DDDA and how you can reduce your dry eye symptoms. 

Digital Screen Time: Increased Amount 

The rising digital work is one cause of PDE. A study reported the effects of blinking when using a digital device and it demonstrated a 50% decrease in blinks per minute while viewing an electronic display. The decreased blinking rate results in the tear film being disrupted, evaporating and causing feelings of discomfort and pain. 
To help combat the reduced blinking rate, remember the 20/20/20 rule. Every 20 minutes, look 20 feet away for 20 seconds. This will give your eyes a digital break and allow you to be mindful to blink. I recommend setting an alarm on your phone to give reminders. 
Another tip is to keep your eye drops near your working area so you can easily reach for them when your eyes are feeling dry. I would also recommend a humidifier to add moisture to your environment and prevent further dryness.

Diet: High Inflammatory Diet 

Working at home during the pandemic has some perks. You can be in your pajamas all day, you don’t have to commute and you can cook at home! However, some individuals may be ordering in or making meals with little nutritional substance. The common saying, “You are what you eat” holds truth especially in the dry eye world. There are direct impacts on your ocular health if you have a poor diet.
The pandemic has resulted in many people indulging in a  higher than usual inflammatory diet consisting of processed foods, meats and cheese as well as increased caffeine and alcohol consumption. This type of diet increases inflammation and worsens dry eyes. You should drink lots of water for hydration, reduce caffeine intake and stay away from sugary drinks. It’s important to address this in your diet and balance your omega-6 intake with increased omega-3 intake.
Omega-3 fatty acids (OFA’s) have been shown to have many health benefits such as lowering high blood pressure, and reducing heart disease. They do all this by lowering inflammation in our bodies – the starting point for most diseases. Since dry eye is a disease caused by inflammation, OFA’s are an important part of a dry eye treatment because of its anti-inflammatory effect. 
2019 meta-analysis study provided evidence that OFA’s supplementation significantly improved dry eye signs and symptoms.  However, not all OFA’s are created equal. Ensure your OFA’s is in re-esterified triglyceride (rTG) form. Many other fish oil products are low quality, unpurified or are sold in synthetic, ethyl ester form. OFA’s that are in rTG form remove toxins and allow for better absorption in the body. Next, look for an optimal ratio of 3:1 EPA vs. DHA and a daily serving of >2000 mg EPA/DHA for full anti-inflammatory effect. In the eye doctor’s cabinet, PRN Omega-3 or I-VU Omega-3 Plus would check off all three needs. 

Distress: Rising Levels of Anxiety

During these unprecedented times, anxiety is at an all time high. People are fearful of losing their jobs, getting sick from COVID-19 or they are experiencing lockdown fatigue. Ultimately, when our cortisol levels (aka our stress hormone) are high, we feel more stressed. There are studies that suggest stress, anxiety, sleep disorders and depression may contribute to the initiation and exacerbation of dry eyes. Painful dry eye symptoms are triggered by specialized nerve receptors on our cornea that are hypersensitive during times of distress. 
To reduce dry eye symptoms associated with rising levels of anxiety, it’s vital to get a full 7-8 hours of sleep. When you are asleep, your body is recovering and your eyes need that time to heal. You should also find an activity or hobby that you enjoy to reduce stress levels. Try light exercises such as yoga, meditation or reading a good novel.  Lastly, don’t forget to speak to someone if you are experiencing high levels of stress or anxiety. Reach out to a friend, family member or a colleague. We’re all in this together and you don’t have to suffer alone.

Airflow: Mask Associated Dry Eye (MADE)

In the summer of 2020, an ophthalmologist reported high cases of dry eyes in his office. He concluded this was probably due to MADE. How was this conclusion hypothesized? Well, people who wear glasses know the annoyance of fogging. The turbulent air from your breath flows through your mask and fogs your glasses. This same air also makes its way into your eyes. 
Any forceful movement of air into the eye causes the tears to evaporate faster. Imagine being in your car with the air conditioning or heater on high. Within a few minutes, your skin starts to feel dry and your eyes as well. 
Masks are probably going to stay for the long haul so it’s important to know how you combat MADE. The researchers at Centre for Ocular Research & Education (CORE) created this infographic that outlines what you can do to prevent MADE. 


If you are suffering from PDE, speak to your dry eye doctor. They are well-equipped and knowledgeable in this specialized field. Contact your nearest MyDryEye clinic and get the help you deserve to reduce your dry eye symptoms. 

March 14, 2021

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