CHU Gabriel-Montpied, Clermont-Ferrand, France.
Service d'ophtalmologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
J Fr Ophtalmol. 2024 Jun;47(6):104170. doi: 10.1016/j.jfo.2024.104170. Epub 2024 Apr 2.
Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.
普遍佩戴口罩是减少 SARS-CoV-2 传播的有效公共卫生干预措施，尤其是在封闭的公共场所和医疗环境中。人们担心 SARS-CoV-2 可能会通过眼部分泌物传播，这导致在眼科手术中采取了额外的防护措施。然而，有证据表明，手术口罩的上边缘会向眼部表面喷射空气，尤其是当口罩佩戴不贴合时。呼气时，长时间向眼部表面喷射气流可能会改变泪膜稳定性，导致高渗和眼表面炎症。这也引发了一个问题，即眼部表面是否会被气流从口腔带到眼部而受到污染，从而增加眼部感染的风险。在此，我们回顾了患者戴口罩对面部、眼睑和眼部感染风险的影响，特别是在眼部手术期间。有证据表明，在强制戴口罩期间，干眼症或眼睑疾病的发病率增加。虽然高日常暴露与直接关联一致，但各种混杂因素可能会影响 COVID-19 大流行期间的眼部健康，从而减轻这种关联。一项回顾性研究报告称，由于患者戴口罩，包括培养阳性的眼内炎，接受玻璃体腔内注射后发生眼内炎的风险可能增加。已经有一些措施被证明可以预防或限制在进行玻璃体腔内注射时发生干眼症或恶化、眼睑囊肿和眼部感染的风险。
