A New COVID-Related Problem: Mask-Associated Chalazia

By Marguerite McDonald, MD, FACS

A growing body of evidence makes it clear that properly worn face masks—along with social distancing—effectively prevent transmission of COVID-19, and, potentially, save lives.

At the same time, masks can cause a variety of relatively minor irritants, including “maskne” and dry eye. In recent months, we’ve added another complaint to that list: chalazion.

A few months ago, we began to notice an increase in the number of patients presenting with chalazion. In fact, records indicate that, within our practice, chalazion cases in 2020 have increased by as much as 25 percent in some of our offices compared to previous years.

There was one additional factor that caused me to suspect a correlation between chalazion increase and mask-wearing: The majority of chalazia we saw in 2020 affected the lower lids.

My operating theory is that the mask “pins” the lower lids, so that the patient’s blink is incomplete. Incomplete blinking causes stagnation of meibum in the glands, which can lead to chalazion formation.

Further investigation confirmed that patients most likely to present with chalazion were those whose occupations require consistent, prolonged mask-use, such as healthcare workers, teachers, restaurant and retail workers, delivery personnel, etc.

By contrast, few cases were reported among those who work at home, without masks, in front of their computers.

Consultation with numerous colleagues revealed that they too had experienced an increase in patients presenting with chalazion. And our hypothesis regarding a connection between the increased incidence and mask-wearing was further supported by an article in the August edition of Occupational and Environmental Medicine, which described a cluster of chalazion cases among nurses working in an intensive care unit caring for COVID-19 patients, and wearing personal protective equipment, including face coverings, throughout their shifts.

As we know, chalazia are caused by obstruction of the meibomian glands and occur most often in patients with inflammatory conditions like chronic blepharitis, seborrhea, acne, rosacea, or long-term inflammation of the lids. They also are more common in patients with a history of viral conjunctivitis or chronic conjunctival irritation.

As they typically are not painful (though they can be, when palpated in the earliest stages) and often resolve on their own, not all chalazia will require treatment. For those that do, treatment for face-mask associated chalazion is the same as in other cases: Topical antibiotic and anti-inflammatory agents, along with warm compresses. For longstanding chalazia that are cosmetically bothersome to the patient, in-office excision is performed.

As prevention, we suggest patients drop masks briefly when they are in situations where they can SAFELY do so without putting themselves or others at risk.

Recently approved vaccines hold great promise for eradicating COVID-19. But until those vaccines are available to all of us, masks will remain part of daily life. So, it’s imperative that we recognize side effects of mask-wearing in order to make patients as comfortable and as safe as possible.

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