The good and the bad during COVID-19

During the COVID-19 pandemic, ODs have seen changes, both good and bad, in eye hygiene. Although some patients appear to be more aware of their eye health, the eye hygiene and contact lens habits of other patients have deteriorated significantly.

THE BAD

Degraded eye hygiene

ODs may sometimes think they sound like scratched discs when reminding patients with dry eye to use artificial tears, or patients with blepharitis to maintain clean eyelid margins, and other patients with contact lenses to wear contact lenses as directed. Sadly, the last year spent at home in seclusion may have been one of the worst for eye hygiene.

Although no transmission of COVID-19 through contact lenses has been reported,1 some patients say they have avoided touching their eyes for fear of causing infection or transmission of COVID-19. Others say they are extending contact lens supplies for a variety of reasons, including loss of vision insurance, fear of running out of lenses, and lack of protective eyewear.

When avoiding touching the eyes and face, staph bacteria on the eyelids, eyelashes and biofilm on the edges of the eyelids may not be removed regularly, leading to an increased incidence of eye inflammation. To make matters worse, patients with contact lenses with blepharitis and meibomian gland dysfunction (MGD) usually experience worsening lipid buildup and deposits on their contact lenses.2.3

Poor eye hygiene and contact lenses

When poor eye hygiene is combined with poor contact lens hygiene, the result can be a vicious cycle of local inflammation including bacterial hordeolums and non-infectious chalazions attributed to blocked meibomian glands.

To make matters worse, patients with or without contact lenses who were not already treating dry eye or blepharitis before the pandemic may also experience additional eye insults from mask-associated dry eye, associated with reduced rates of eye contact. blink due to increased use of digital devices.2

The tear film acts as an essential barrier against pathogen invasion, and it can be compromised if an ill-fitting mask or excessive computer use causes faster evaporation.2.3 Although universal, the use of public masks has been essential during the COVID-19 pandemic to reduce disease transmission through the mouth and nose, the eye remains unprotected and vulnerable to infections. In addition, the eyes can be further compromised by irritation from an ill-fitting mask.2

Bacteria exhaled behind ill-fitting masks may have worsened eye hygiene and styes during the pandemic. The humid environment under the masks, created by our own breath, creates a fertile ground for organisms, including bacteria, fungi and Demodex mites develop.2 Styes, blepharitis and Demodex infestations can get out of hand quickly if left untreated.

Recommendations

Options are available to improve eye hygiene. Avenova (NovaBay), a 0.01% hypochlorous acid spray, is available over the counter to kill viruses and bacteria that can cause MGD and symptoms associated with blepharitis.3 Sprayed twice a day to clean lashes and eyelids, Avenova can help patients with contact lens intolerance and other chronic eye problems. NovaBay claims that Avenova is effective against SARS-CoV-2 on hard surfaces.3

Eyelid wipes such as OCuSOFT Eyelid Scrubs can help remove debris, excess oil, and dead skin cells from the edge of the eyelid without negative effects on tear breakage time or skin staining. the ocular surface.4 I recommend OCuSOFT Lid Scrub Plus because its formulation does not require rinsing which increases convenience. Cliradex wipes are a preservative-free option that includes a recommended tea tree oil ingredient when Demodex folliculorum is suspected.4

Almost half of blepharitis cases in the United States are caused by Demodex dust mites. Tarsus Pharmaceuticals’ proposed drop formulation, if approved, would be the first to treat Demodex-associated blepharitis. Tarsus recently announced the start of its Phase 3 trials for TP-03.5.6

GOOD

Improved eye hygiene

Although some patients experienced deteriorated eye hygiene during the pandemic, time spent in quarantine has changed others’ views on the importance of good health. As a result, some patients have reported more diligent use of artificial tears, eyelid scrubs, hot compress masks, and other home treatment options previously recommended by their eye care professionals.

Interestingly, research shows that contact lens adhesion and hand washing before contact lens application and removal have improved dramatically during the pandemic.7 This is probably due to the growing public awareness of hand washing habits. Since the height of the pandemic, many patients have learned about lens modalities and daily disposable options after considering the convenience, comfort and quality compared to other lenses.

Advices

To further encourage good hygiene, I have been diligent in educating patients about the importance of maintaining optimal eye health. If a symptomatic patient has worn extended wear lenses, the pandemic has presented the perfect excuse to get to the root of the problem, be it lens fit, modality, materials, or even ‘untreated eye surface disease due to poor eye hygiene.

Rather than viewing a patient’s symptoms as normal, consider offering a trial of a daily disposable lens to compare with a current extended wear pattern. Providing patients with the opportunity to try daily disposables has helped me transition to daily lenses throughout the pandemic.

To ensure best hygienic practices for patients wearing extended wear lenses, I recommend hydrogen peroxide disinfection such as ClearCare (Alcon).8 Educating patients about proper disinfection revealed that very few people read the instructions.

Patients need and appreciate a reminder of the basics of eye hygiene, including the importance of keeping eyelids and eyelashes clean, washing hands before applying and removing lenses, and how to disinfect lenses. of contact. DOs need to continue to reiterate the importance of good eye health, and they may need to offer new counseling during a pandemic.

The references

1. Jones L, Walsh K, Willcox M, Morgan P, Nichols J. The COVID-19 pandemic: Important considerations for contact lens practitioners. Front Eye Cont lens. 2020; 43 (3): 196-203. doi: 10.1016 / j.clae.2020.03.012

2. Moshirfar M, West WB Jr, Marx DP. Eye irritation and dryness associated with the face mask. Ophthalmol Ther. 2020; 9 (3): 397-400. doi: 10.1007 / s40123-020-00282-6

3. Sindt CW. Wash away your old hygiene strategy. Examination of the cornea and contact lenses. May 15, 2014. Accessed May 10, 2021. https: // www. reviewofcontactlenses.com/article/wash-away-your-old-hygiene-strategy

4. Murphy O, O’Dwyer V, Lloyd-McKernan A. The effect of eyelid hygiene on tear film and ocular surface, and the prevalence of Demodex blepharitis in university students. Anterior Eye Cont lens. 2020; 43 (2): 159-168. doi: 10.1016 / j.clae.2019.09.003

5. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. il sec in the study of the offspring of beaver dams: prevalence, risk factors and health-related quality of life. Am J Ophthalmol. 2014; 157 (4): 799806. doi: 10.1016 / j.ajo.2013.12.023

6. Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Epidemiology and Risk Factors Associated with MGD. Invest Ophthalmol Vis Sci. 2011; 52 (4): 1994-2005. doi: 10.1167 / iovs.10-6997e

7. Vianya-Estopa M, Wolffsohn JS, Beukes E, Trott M, Smith L, Allen PM. Compliance of soft contact lens wearers during the COVID-19 pandemic. Front Eye Cont lens. Published online August 14, 2020. doi: 10.1016 / j.clae.2020.08.003

8. Contact lens care systems and solutions. Centers for Disaster Control and Prevention. Updated September 11, 2020. Accessed May 10, 2021. https: // www. cdc.gov/contactlenses/care-systems.html#hydrogen-peroxide


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