Eye Experts Discuss the Role of Artificial Tears In the Midst of Infectious Outbreak

There are still unanswered questions surrounding the use of artificial tears that have been linked to a Pseudomonas aeruginosa outbreak. The outbreak has affected 64 individuals across 13 different states, resulting in 8 cases of vision loss, as well as lung and urinary tract infections, and tragically, one death.

Federal agencies have issued warnings advising people to discontinue use of EzriCare and Delsam Pharma artificial tears. Tests conducted on opened bottles used by those affected revealed the presence of a rare, extensively drug-resistant strain of P. aeruginosa, which has never before been reported in the United States. Please note that this external link to nei.nih.gov will open in a new browser window or tab.

The Centers for Disease Control and Prevention (CDC) are currently conducting an investigation into the source of the virulent strain of P. aeruginosa found in the artificial tear bottles. It is currently unclear whether the contamination occurred during or after the manufacturing process. The CDC is also continuing to conduct tests on unopened bottles. Further information is being sought about each case of infection to better understand the outbreak.

“We are actively gathering more information about long-term patient outcomes, particularly for patients with eye infections,” said Curtis Gill, a spokesperson for the CDC.

It is evident that eye health experts have recommendations for individuals who use artificial tears, which can be purchased without a prescription and are frequently used to alleviate eye irritation associated with dry eye disease, contact lens wear, and refractive surgery. These eye drops are also frequently used by those who use other types of eye drops regularly, such as individuals with glaucoma.

Need preservative free? Use single-dose vials

The brands that have been recalled are preservative-free, which is a recommended formulation for individuals who use artificial tears more than four times per day.

“Formulations with preservatives reduce the risk of bacterial growth and potential infection. However, commonly added preservatives such as benzalkonium chloride, polyquaternium, or sodium chlorite themselves can be irritating to the eye, especially if used 5 or more times a day,” said Dr. Chantal Cousineau-Krieger, M.D., an ophthalmologist at the NEI.

It is important to note that the recalled brands were not only preservative-free, but were also sold in bottles containing multiple doses. Repeated use of an eye drop bottle that lacks preservatives may create an opportunity for contamination. This is particularly concerning if the contamination involves a pathogenic micro-organism, as this increases the risk of a severe ocular infection, according to an expert.

“People who require preservative-free artificial tears can purchase single-use, individual dose vials, which cut contamination risk significantly,” Krieger said.

It is worth mentioning that certain preservative-free artificial tears are sold in bottles with advanced designs intended to prevent contamination. Some brands come in vials that feature a special tip blocking airflow back into the bottle, enabling the drops to remain sterile for a longer period after opening.

Individuals who use eye drops of any kind should wash their hands thoroughly prior to application and avoid touching the tip of the bottle to their eye or eyelids. This can help reduce the risk of contamination of both the tip and the contents of the bottle.