CDC Says These Eye Drops Are Linked to a Serious Bacterial Infection
CDC is asking people to stop using EzriCare Artificial Tears.
The eye drops have been linked to a serious bacterial infection, and Global Pharma Healthcare is issuing a voluntary recall.
At least three people have suffered permanent vision loss, and one person has died.
The Centers for Disease Control and Prevention is warning people to steer clear of a particular type of eye drops after the product has been linked to a specific bacterial infection. One person has died and at least three others have permanent vision loss after using EzriCare Artificial Tears, the CDC says in a notice.
The CDC says it is investigating a “multistate cluster” of infections in 55 patients across at least 11 states. Most of the patients had used artificial tears, and the most common type they used was EzriCare Artificial Tears.
People have had serious complications from using these eye drops, including a bloodstream infection that lead to death, the CDC says. Testing shows that the bacteria that cause these infections also appear to be resistant to antibiotics like carbapenem, ceftazidime, and cefepime, the CDC says.
As of now, the CDC says that it “recommends that clinicians and patients immediately discontinue the use of EzriCare Artificial Tears” until its investigation is over.
Global Pharma Healthcare is voluntarily recalling all lots within expiry of their Artificial Tears Lubricant Eye Drops, distributed by /EzriCare, LLC- and Delsam Pharma to the consumer level, due to possible contamination.
The idea of getting a serious bacterial infection from eye drops is terrifying. Here’s what you need to know.
How can bacteria get into eye drops?
It’s important to first go over what eye drops are. Eye drops typically have saline has a base ingredient and they’re generally divided into two camps: those with preservatives and those without, says Mina Massaro-Giordano, M.D., co-director of the Penn Dry Eye & Ocular Surface Center and a professor of clinical ophthalmology at the University of Pennsylvania. “Eye drops with preservatives should prevent bacterial growth,” she says. “But the preservative-free ones are used for one day and thrown out, so there’s not really time for bacterial growth.”
This particular cluster of infections is linked to Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA), aka VIM-CRPA. “This is a fairly aggressive bacteria and it being resistant to several types of antibiotics is even more dangerous,” says Benjamin Bert, M.D., an ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif.
“Something like this happening on a mass scale is very, very rare,” Dr. Bert says. “Most eye drops are prepared in sterile facilities, so the drops are all completely sterile.”
There are two main ways bacteria could get into eye drops, Dr. Massaro-Giordano says. One is during the manufacturing process itself, she says. If the drops have no preservatives or the bacteria is resistant to the preservatives, bacteria could grow, she explains. This is the particularly dangerous, because the bacteria has more time to proliferate before it reaches your eyes, Dr. Bert says.
It’s also possible for a user to contaminate eye drops with bacteria that naturally lives around the eye, Dr. Massaro-Giordano says. “If you’re using a tube, stick it around your eye and there are no preservatives in the drops, you could infect the tube or packet,” she says. The bacteria could then grow inside the container and end up in your eye at a high dose if you re-use the packet—a scenario Dr. Massaro-Giordano says is more likely to happen with preservative-free drops, which are typically designed to be one-time use. Meaning, you shouldn’t re-use a vial once you’ve opened and used it once.
“Widespread contamination is not very common,” says Jamie Alan, Ph.D., Pharm.D., associate professor of pharmacology and toxicology at Michigan State University. “A small amount of contamination—like touching the tip of the dropper bottle—probably happens often.”
In general, “preservative-free eye drops may be more prone to problems like this because they do not contain preservatives,” says Peter Hersh, M.D., a clinical faculty member in the Department Of Ophthalmology & Visual Science at Rutgers New Jersey Medical School.
“In this case, [contamination] was likely from manufacturing, since so many bottles were contaminated,” says Vivian Shibayama, O.D., an optometrist with UCLA Health. However, details of what, exactly, happened are scarce.
EzriCare didn’t respond to Prevention’s request for comment by deadline.
Is there any way to know if your eye drops are contaminated?
Not really. Many eye drops come in containers that aren’t clear, so it’s difficult to see what the liquid inside looks like before you use it, Dr. Massaro-Giordano says. “However, if you look at the fluid and it looks slightly cloudy when it was previously clear, it may be an indication” of contamination, she says. Another potential sign, per Dr. Hersh: The dropper nozzle could have discoloration or build-up.
But some individual use packets are slightly cloudy to begin with, Dr. Massaro-Giordano says, making it “almost impossible” to tell by looking at eye drops if they’re contaminated.
Signs of a bacterial eye infection
It can be difficult to tell a bacterial eye infection from infections caused by other things, like viruses and fungi, Dr. Massaro-Giordano says. In general, though, these are the main signs of an eye infection, per Medline Plus:
Redness
Itching
Swelling
Discharge
Pain
Problems with vision
Bacterial infections are usually more rare than viral infections, but they may have more severe symptoms, Dr. Massaro-Giordano says. “The eye will be a lot more red and the patient may feel more discomfort,” she says. “There also may be a lot of mucousy discharge.”
When to see a doctor for a bacterial eye infection
If you suspect you have a bacterial eye infection, Dr. Massaro-Giordano says it’s important to see your doctor ASAP. “If your eye turns red and crusty, and it’s not getting better after a day or two, get in to see someone,” she says.
Doctors stress that it’s not common to get a bacterial eye infection from eye drops, though. “It’s exceedingly rare,” Dr. Massaro-Giordano says. However, if you want to be safe, Dr. Hersh recommends tossing single-use vials after one use and storing your medications in a clean area. Also, “avoid touching the tip of the medication bottle” so that you don’t accidentally contaminate it, he says.
If you’re given the choice between having single-use preservative-free drops and a bottled version, it’s important to opt for the single-use variety, Dr. Shibayama says. “Preservative-free tears in single vials are safer than preservative-free tears in a bottle,” she says, noting that bacteria can build up in bottles over time.
Another tip, per Dr. Bert: Toss your eye drop bottles that aren’t single use within a month after opening them, even if they haven’t expired yet. “Once it’s exposed to air, it’s possible for bacteria to get in and contaminate it,” he says.
And, if you develop symptom of an eye infection, see your doctor quickly. Bacterial infections in particular can get worse if they’re left alone, so proper, speedy treatment is important, Dr. Massaro-Giordano says.
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