Purpose The aim of this cohort study was to describe the change in ocular surface signs and symptoms before and during the COVID-19 pandemic, and to associate changes with potential pandemic-related events. Methods First-visit patients from 2019 to 2021 were examined for corneal staining, lacrimal function and refraction. We assessed the presence of seven common ocular symptoms. Patients with glaucoma and macular disease were excluded. Dry eye (DE) was diagnosed according to the criteria of the Asia Dry Eye Society. Results The mean age of 3,907 participants was 59.6±18.6y and 63.8% were female. Mean age and the prevalence of diagnosed DE and shortened tear break-up time decreased from 2019 to 2021. The prevalence of eye fatigue, blurring and photophobia decreased in 2020. Conclusions The prevalence of diagnosed DE did not increase among first-visit patients during the pandemic compared with 2019, despite many survey results suggesting that DE may have worsened due to frequent masking, increased screen time, mental stress, and depression under quarantine and social infection control. It might be considered however, that many elderly DE patients might have refrained from consulting an ophthalmologist and possibly delayed treatment of DE during the pandemic.
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