Putting the eye drop scare into focus

April 06, 2023
Someone else's hand aims an eye drop at woman's right eye. She has curly shoulder length hair.
Recent recalls of certain brands of eye drops have left some users confused. iStock

As the Centers for Disease Control and Prevention warns in The New York Times that a drug-resistant bacteria linked to imported eyedrops could become a persistent problem in health care sites and can spread person to person, the head of the MUSC Health Storm Eye Institute is keeping a close watch on the situation. “I’m highly concerned. But the good news is, so far, that at Storm Eye and in the Lowcountry, I know of no cases,” said Andrew Eiseman, M.D.

A spokesperson for the South Carolina Department of Health and Environmental Control said that as of the end of March, the agency wasn’t aware of any cases of the drug-resistant strain of bacteria in the state either.

So which eye drops are affected, what’s wrong with them and what do eye drop users and the people around them need to know?

The eye drops

The CDC said people should stop using EzriCare and Delsam Pharma’s Artificial Tears for now. The affected eye drops were made in India and imported to the United States. The Food and Drug Administration has inspected the Global Pharma site where they were produced and found issues with cleaning and maintenance processes.

In the most recent update on its website, the CDC reported that about 70 people across 16 states have been infected with a rare strain of drug-resistant Pseudomonas aeruginosa associated with the contaminated eye drops. The majority of them had used EzriCare Artificial Tears.

Doctor in a white coat sis looking at equipment His right hand is on a computer mouse. 
Dr. Andrew Eiseman leads the MUSC Health Storm Eye Institute. Photo by Brennan Wesley

Global Pharma has also recalled a batch of Delsa Pharma Artificial Eye Ointment that was made in the same factory as the eye drops. And another company, Apotex, has recalled six lots of glaucoma drops called Apotex Brimonidine Tartrate Ophthalmic Solution, 0.15%, over concerns involving cracks in the containers’ caps. 

Eye drops and eye wash are big business. According to Statista, by next year, the number of Americans who use them may top 123 million. Dry eye, one of the main reasons for using eye drops, affects enough people for the Storm Eye Institute to have a Dry Eye Center.

They can be a big help for people dealing with dryness, irritation and other mild problems, Eiseman said. “They have figured out which drops were responsible for the problems, and I think it’s still highly safe to use over the counter artificial tears available in the market.”

The bacteria

Eiseman has seen plenty of people with Pseudomonas aeruginosa in his work at the Storm Eye Institute, but not the drug-resistant strain that’s stirred up so much worry. It’s never been reported in the United States before.

“We see Pseudomonas ulcers all the time. They are one of the top contact lens-related ulcers – not related to contaminated eye drops,” Eiseman said.

His team at Storm Eye, which he said offers the largest and most diverse academic ophthalmology practice in the state, takes eye ulcers very seriously. Ophthalmologists are doctors with extensive medical and surgical training in eye care.

“When we see corneal ulcers, we typically scrape the cornea and then we put those scrapings directly onto bacterial growth plates, and we culture it because we initially treat with broad spectrum antibiotics to treat the most common offending infectious organisms,” Eiseman said.

“We then use the results of the cultures to tailor our treatment to the organism identified and to ensure that the organism is sensitive to the antibiotics available. Many corneal ulcers require that specially prepared compounded, fortified antibiotics are used every hour around the clock.”

So that tells you how challenging Pseudomonas aeruginosa can be. Treatable, but tough. But that’s before the arrival of the new drug-resistant strain.

“What’s really scary is when it genetically mutates and is no longer sensitive to the normal antibiotics that we use. This new strain, unfortunately, is not sensitive to the most common antibiotics that we use. And that’s how it goes from the surface of the eye to inside the eye. And that’s how it can get to other places in the body.”

He said the tear drainage system goes through the upper and lower lid and then into the nose. 

“So if you have contaminated bacteria on your eye, it can get into your nose and beyond. There are several lung infections associated with the drug-resistant bacteria. There are patients who had blood infections, which is basically what we term ‘sepsis.’ A couple people have died because of it. There have been several people who have permanently lost vision, and several folks had their eyes surgically removed because the infection spread so significantly.”

What’s next?

Eiseman said the eye drop problem is waning as people get rid of the affected products. He’ll wait to see if it goes away entirely. He credits government investigators for their work in isolating the issue and getting the word out to consumers. 

But Eiseman also knows the drug-resistant Pseudomonas can be really tough to get rid of because it loves moist environments such as drains and water faucets. And the CDC said the bacteria has another trick up its sleeve: It managed to spread person to person in a Connecticut health care center. 

For now, Eiseman had this advice: “If you start using eyedrops and your eyes get red or irritated, you need to seek immediate care from an eye care specialist.”

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