Mask-associated dry eye disease following short-term facemask wear with or without nasal bridge taping among health workers at a Nigerian tertiary care facility: a cross-over randomized clinical trial

Mask-Associated Dry Eye disease (MADE) has been linked to facemask wear predominantly because of the upward flow of expired air towards the eyes. Taping the rim of the mask to the nasal bridge has been proposed to reduce MADE. This study compared dry eye disease rates following short-term face mask wear with or without taping the nasal bridge among health workers in National Hospital Abuja. This was a cross-over randomized clinical trial conducted between February and July 2024 at National Hospital Abuja. It involved 77 health workers recruited according to their work environments (Open = 38 and Restricted = 39) using a stratified sampling method. Participants completed a modified MADE Questionnaire to assess MADE risk factors and symptoms. Dry eye symptom scores, Schirmer’s test values, Tear Break-Up Time (TBUT), and Oxford ocular surface staining scores were measured before and after six hours of facemask wear, with and without nasal bridge taping, on two separate days. Participants were randomized into group A or B corresponding to facemask wear without taping or with taping on the 1st day. MADE was defined as presence of dry eye symptoms plus an abnormal TBUT, Schirmer’s or Oxford corneal staining score post-facemask wear. Descriptive statistics, paired T-test, ANOVA, binary logistic regression and crossover analysis were used to analyze data using SPSS version 26, with statistical significance set at p < 0.05. The mean age of participants was 32.40 ± 9.14 years, with a male to female ratio of 1:2.21. There was a statistically significant difference in all outcome variables pre and post facemask wear with and without taping at the nasal bridge ( p < 0.05). TBUT and Oxford scores showed greater improvement post-taped mask wear when compared with mask wear without taping (7.40 ± 2.24 s vs. 5.63 ± 1.82 s; and 0.23 ± 0.43 vs. 0.51 ± 0.70; p < 0.001). MADE developed in 14.3% of participants after facemask wear without taping, versus 3.9% with taping. Working in open environments was identified as a predictor of MADE in the non-taping group (OR: 0.111, p = 0.019). Crossover analysis showed significant carry-over effects in outcome variables. Short-term facemask wear can result in dry eye disease and taping facemasks at the nasal bridge can reduce these effects. Retrospectively registered with the Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/ ) on August 1, 2025 PACTR202508721722676 .