Recalled Eye Drops Linked to Infections, Vision Loss

Jul 15, 2023

Ezricare/Verywell

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are advising healthcare providers and consumers to stop using and avoid buying EzriCare Artificial Tears, which might be the source of multiple drug-resistant infections.

Here’s what experts say you should know about the risks associated with using the eye drops, and what to do if you’ve been using them.

According to a health alert issued by the CDC on Wednesday, the eye drops might be contaminated and linked to an outbreak of Pseudomonas aeruginosa, a type of bacteria that can cause infections in the blood, lungs, or other parts of the body.

Martha Sharan, a spokesperson for the CDC’s Division of Healthcare Quality Promotion, told Verywell that Pseudomonas aeruginosa is getting harder to treat because of antibiotic resistance, which happens when germs no longer respond to the antibiotics designed to kill them.

“These bacteria are constantly finding new ways to avoid the effects of antibiotics used to treat the infections they cause,” said Sharan. “If they develop resistance to several types of antibiotics, these germs can become multidrug-resistant.”

As of January 31, the CDC had identified at least 55 patients in 12 states with infections that led to permanent vision loss, hospitalization, and one death. Other patients developed inflammation in the cornea part of the eye (keratitis), inflammation of the fluid in the eye (endophthalmitis), respiratory infections, urinary tract infections, and serious blood infection (sepsis).

According to the CDC, most patients with infections reported using one of 10 different brands of eye drops. However, eye drops from EzriCare, a preservative-free, over-the-counter (OTC) product, were the most common.

During laboratory testing, the CDC identified the pseudomonas bacteria in opened bottles of EzriCare artificial tears. They are currently testing unopened bottles of the product to determine if the bottles were contaminated during the manufacturing process.

While there has not been an official recall of the product by the CDC or FDA, both agencies are recommending that healthcare providers and patients immediately stop using EzriCare artificial tears until additional guidance is released.

“We immediately took action to stop any further distribution or sale of EzriCare Artificial Tears. To the greatest extent possible, we have been contacting customers to advise them against [the] continued use of the product,” EzriCare said in a statement.

The eye drops are manufactured in India by Global Pharma Healthcare, which issued a voluntary nationwide recall of the product in response to the possible contamination.

Global Pharma Healthcare/EzriCare

Whether you’ve been using EzriCare eye drops or not, redness, pain, and discharge are some of the early signs and symptoms of an eye problem, Benjamin Bert, MD, an ophthalmologist at MemorialCare Orange Coast Medical Center, told Verywell.

Other symptoms of a potential eye infection include:

Bert said that most symptoms of eye infections are in the eye, but some people may also have symptoms in their nose and throat.

“If someone has bad sinus pain, sinus infection, or nasal inflammation and they’ve been using these EzriCare drops, there does have to be a little bit of suspicion of the bacteria potentially irritating the nasal or sinus pathways,” he said.

If you have any of the symptoms above or anything out of the ordinary, Laura Di Meglio, OD, instructor of ophthalmology at the Johns Hopkins University School of Medicine, said to contact your eye care provider—especially if you wear contacts, which makes you more prone to infections.

“If you are using a drop and you’re not getting a good outcome, stop using it immediately,” Di Meglio told Verywell. “Drops should never make things worse. Check it out with your primary eye care provider to make sure everything is OK.”

EzriCare is a preservative-free and generic form of artificial tears, which are just lubricant moisturizing drops,

According to Bert, eye drops labeled “preservative-free” do not have added ingredients or chemicals in them that help maintain the drops for a longer time.

Once preservative-free eye drops have been opened and exposed to the air, Bert said you do not want to use them after 24 hours. Bacteria and other germs in the air could get into the product and potentially contaminate it.

Di Meglio said that eye drops that do have preservatives in them can last up to about 30 days because the added chemicals “help fight off any bacterial growth that may come into the bottle.”

That said, Bert emphasized that bacteria can form in any eye drops—whether they’re preservative-free or not. The difference is how fast the bacteria can grow.

“If the drop is preserved, it should break down slower and it should resist a little bit more the growth of bacteria,” Bert said. “But any artificial tears can actually allow bacteria to grow.”

Other factors can potentially contaminate eye drops. If the eyedropper touches any surface (including the surface of the eye), it can pick up bacteria and potentially contaminate the product.

Even though preservative-free eye drops do not contain the ingredients that help prevent bacterial growth, experts say that people should not fear using them—in fact, there are often benefits to doing so.

Bert said that one advantage of preservative-free eye drops is they can be used multiple times a day for dry eyes or other irritation. In addition, some people have allergies to the preservatives that are used in the drops and may have an adverse reaction to them.

“The preservative that’s used in eye drops can become an irritant,” Bert said. “If you’re needing to use a drop more than four or six times in a day, you want to use a preservative-free formulation, because the preservative can become its own irritation and actually start to work against you.”

Di Meglio said that the biggest downside of preservative-free drops is that since they cannot be kept indefinitely and are thrown away frequently, they can produce a little more waste and may not be as environmentally friendly compared to other options.

“I wouldn’t shy away from them too quickly, because they definitely have their place in their effectiveness,” said Di Meglio. “If used properly and according to how it’s prescribed, then there should be pretty much no chance of anything coming back in those bottles or in the vials to lead to the ability of bacteria to grow.”

If you use EzriCare eye drops or have them but have not used them yet, Bert said that you should stop using them, throw the product away, monitor your eyes for any signs of infection, and contact your eye care provider right away if you start having symptoms.

If your provider advised you to use EzriCare artificial tears, Sharan said that you should check in with them about recommendations for other treatment options.

It’s hard to broadly recommend eye drop alternatives since each person’s needs and eye health will be different. Instead, patients should ask their eye care provider about what would be best for them.

“I usually pick a specific artificial tear drop for each patient to use based on what I see as deficient in their tears or in their tear film,” Bert said. “If you are looking for a new eye drop or have any concerns, it’s a very easy first step to see your eye doctor.”

If you’ve been using EzriCare Artificial Tears, stop using them and throw the product away. If you need to use eye drops to treat a condition like dry eye, ask your provider about another product you could use to manage your symptoms.

Food and Drug Administration. FDA warns consumers not to purchase or use EzriCare Artificial Tears due to potential contamination.

Centers for Disease Control and Prevention. Outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with artificial tears.

Centers for Disease Control and Prevention. Pseudomonas aeruginosa in healthcare settings.

Food and Drug Administration. Global Pharma Healthcare issues voluntary nationwide recall of artificial tears lubricant eye drops due to possible contamination.

Centers for Disease Control and Prevention. Outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with artificial tears.

By Alyssa HuiAlyssa Hui is a St. Louis-based health and science news writer. She was the 2020 recipient of the Midwest Broadcast Journalists Association Jack Shelley Award.