Here’s What Eye Experts Recommend After Outbreak Of Rare, Deadly Infections Linked To Eye Drops

  BuzzFeed News; EzriCare
BuzzFeed News; EzriCare

If you have “artificial tears” eye drops in your home, check to make sure you don’t have one of these recently recalled products.

Two companies, EzriCare and Delsam Pharma, recalled their eye drops this month after a rare, drug-resistant bacteria called Pseudomonas aeruginosa caused infections in 55 people across 12 states. At least five people who used the drops had permanent vision loss as a result of cornea infections, and one person died when the infection spread into their bloodstream.

The products, which are used to treat dry or irritated eyes, are free of preservatives and come in a multi-dose bottle.

We asked experts about the recall, what drops are safe to use, and how to prevent eye infections in general from drops.

Eye infection symptoms to be concerned about

The CDC issued a health alert, asking people and healthcare providers to immediately discontinue use of the recalled drops. Anyone who has used EzriCare artificial tears should look for signs of infection and get tested if necessary, they said.

According to the CDC, users of EzriCare artificial tears should reach out to their healthcare providers if they have the following symptoms:

  • discharge from the eye

  • eye pain or discomfort

  • redness of the eye or eyelid

  • feelings of something in the eye

  • increased sensitivity to light

  • blurry vision

If you have them, you should throw out your EzriCare and Delsam Pharma eye drops and artificial tears products, and you can call or email the manufacturers with any questions. You can also check brand names and product photos on the FDA announcement.

The type of bacteria that contaminated the EzriCare and Delsam Pharma eye drops is a rare and drug-resistant strain, Pseudomonas aeruginosa, which can cause infections in the blood, lungs, and other parts of the body.

Some patients who were using the artificial tears experienced symptoms including keratitis, or inflammation of the cornea; endophthalmitis, or infection of the tissues and fluids in the eye; respiratory infection; urinary tract infection; and sepsis.

Cases occurred in California, Colorado, Connecticut, Florida, New Jersey, New Mexico, New York, Nevada, Texas, Utah, Washington, and Wisconsin.

What to use instead

Dr. Christopher Starr, the clinical spokesperson for the American Academy of Ophthalmology, told BuzzFeed News that there’s no need to avoid other types of eye drops or brands of preservative-free products.

“Only users of EzriCare and Delsam Pharma artificial tears, both manufactured in India by Global Pharma, should be concerned due to the recent recall,” Starr said. “Before putting eyedrops in, everyone should double check the bottle’s label to be certain it isn’t one of these recalled products. But at this time, there is no concern with using other eye drops.”

As a general rule of thumb, you should avoid using eye drops that are past their expiration date and keep the bottle tip clean and free of contamination, Starr said. “Always re-cap the bottle and keep it in a clean location.”

Contamination of eye drops may be related to the design of the packaging — bacteria are most likely to grow on the application containers. Like most products that are preservative-free, products with fewer of these additives are at risk of becoming contaminated with microorganisms, which can increase the risk of developing eye infections.

“Multi-use preservative-free eye drop bottles have a higher risk of infectious contamination because, without antimicrobial preservatives, bacteria and fungus can proliferate, potentially leading to sight-threatening infections,” Starr said. “But because traditional preservatives in high doses — more than 4 drops per day — can be irritating to the ocular surface, we generally recommend preservative-free drops in single-use disposable containers for most people.”

Dr. Chirag J. Patel, a board-certified ophthalmologist at Lake Nona Ophthalmology, also recommends preservative-free drops in single-use containers.

“There is a difference between preservative-free vials and multi-dose bottles. I prefer preservative-free vials for that reason. Since they don’t have antimicrobial preservatives, there is in fact a higher risk of contamination,” Patel said. “The vials are single use and have the lowest risk of contamination and the highest associated benefit of improving tear function.”

There are many other artificial tears brands that people can use to protect their eyes or soothe irritation, Patel said.

“In this regard, I do believe brand awareness is very important. Brand-name tears, such as Refresh, Systane, Theratears, and Optase, provide a consistent product with a trustworthy sterilization and packaging process. These are generally the most clean, and come packaged in individual vials.” Patel said. "Although rare, contamination can prove to have serious consequences, as EzriCare had colonies of resistant Pseudomonas aeruginosa.”

How to apply eye drops to avoid infections

Yes, there’s a right way to put drops in your eyes — and it can keep you safe. Poor technique in using drops, like touching the eyes or skin with the dropper tip, can increase the risk of infection.

Starr recommends tilting the head back, pulling the lower eyelid down and away from the eye, and then dropping the drop from a distance. “When using eye drops, do not let anything come in contact with the bottle tip, especially not the eyeball itself,” he said. “If you’re not sure if the drop got into the eye, it is generally safe to try again.”

Since prescription eye care products can be expensive, you can clean the bottle to help remove contaminants, Starr said.

“If you think your multi-use bottle tip may have been contaminated, I recommend throwing it away or, if [it’s] too expensive or unable to refill the prescription, then clean the tip with alcohol or another anti-infectant and let air dry before reusing,” Starr said. The same rules apply for contact lens solutions: “Never reuse or ’top off’ contact lens storage solutions, as this can increase the risk of eye infections too.” ●

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