Alterations in tear film and wavefront parameters associated with different types of disposable surgical masks in healthcare personnel during working hours: a randomized trial

Background: Facial masks are essential for preventing respiratory infections, particularly among healthcare workers. However, prolonged mask use may lead to ocular surface disruption, known as mask-associated dry eye (MADE). Objectives: To evaluate the impact of different types of disposable surgical masks on tear film parameters and corneal wavefront aberrations during an 8-h work shift. Design: Randomized clinical trial. Methods: Sixty healthcare personnel at Rajavithi Hospital were randomly assigned to three mask groups: Group 1 (earloop surgical mask; Medimask ® ), Group 2 (earloop surgical mask with adhesive nose strip), and Group 3 (anti-fog earloop surgical mask; Welcare 3D Blue Line Anti-Fog Mask ® ). Non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and conjunctival redness were assessed using the Oculus Keratograph ® 5M. Corneal higher-order aberrations (HOAs) were measured using the GALILEI Dual Scheimpflug Analyzer before and after 8 h of mask wear. Results: TMH decreased significantly in all groups: Group 1 from 201.13 ± 85.10 µm to 174.53 ± 42.01 µm ( p = 0.003), Group 2 from 188.81 ± 59.55 µm to 164.61 ± 50.58 µm ( p = 0.036), and Group 3 from 194.50 ± 58.29 µm to 166.25 ± 45.90 µm ( p = 0.034). NIBUT showed slight, non-significant decreases: Group 1 (9.26 ± 4.47–8.35 ± 3.26 s), Group 2 (8.88 ± 3.79–8.20 ± 3.12 s), and Group 3 (9.14 ± 4.20–8.55 ± 3.74 s). Conjunctival redness increased significantly only in Group 1 (1.75 ± 0.47–1.98 ± 0.52, p = 0.048). HOAs were mostly unchanged, except for total HOAs at the 6 mm zone, which were higher in Group 3 (1.85 ± 1.20) than in Group 1 (1.14 ± 0.48) and Group 2 (1.28 ± 0.58; p = 0.012). Conclusion: An 8-h shift of mask use reduced TMH across all groups and increased conjunctival redness in earloop surgical masks without adhesive. Although most optical aberrations remained unchanged, elevated HOAs in the anti-fog earloop surgical mask group may affect vision quality under mesopic conditions. Thai Clinical Trials Registry: TCTR 20230725002 ( https://www.thaiclinicaltrials.org/show/TCTR20230725002 ).