Medical professionals are investigating an outbreak of an antibiotic-resistant microbe found in some bottles of lubricating eye drops or artificial tears.
According to the US Centers for Disease Control and Prevention, a total of 68 infections have been reported to March 14. Three people died, eight lost their sight and four had one eye surgically removed. At the request of the Food and Drug Administration, pharmaceutical company Global Pharma Healthcare has issued a recall on artificial tears and eye ointment sold by EzriCare and Delsam Pharma, based in New Jersey and New York, respectively, although that the products were manufactured in India.
Government agencies say these products were contaminated during manufacture with a rare strain of the bacteria Pseudomonas aeruginosa resistant to common and potent antibiotics known as carbapenems.
“Only users of the specific brands under recall should be affected by the recent recall,” says Christopher Starr, ophthalmologist at Weill Cornell Medicine in New York and clinical spokesperson for the American Academy of Ophthalmology. “Before putting on eye drops, everyone should double-check the bottle label to be sure it is not one of these recalled products. But for now, there is no problem using other eye drops.
American scientist spoke with Christina Prescott, division director of cornea services and vice president of education in the department of ophthalmology at NYU Langone Health, about the infections.
[An edited transcript of the interview follows.]
What do you remember from this epidemic?
Our patients don’t usually die, especially from something that we consider fairly benign, so that’s quite shocking. I think, at least, it brings a lot of awareness to an issue that people have never really thought about.
We see a lot of eye infections. It’s something we’ve always seen with tainted products, products that aren’t made properly. There have been problems in the past with contact lens solutions. Hopefully this will at least make some people more aware of the potential dangers of things that seem rather benign, like artificial tears, and then be more aware of their current practices. So hopefully in the long term this will lead to less eye infections as people become more attentive and develop better habits.
How common are eye infections like this?
Incredibly rare, especially with people dying. There are epidemics from time to time. It seems like every few years there is an outbreak of some sort of tainted solution. But this is the first time I can remember, at least in the United States, seeing issues of actual patient deaths from contaminated eye drops. We have seen many cases of blindness, unfortunately, but death is something new.
How can people stay safe from infections like this?
These eye drops were so called preservative free. Usually with preservative free eye drops we only dispense them in individual bottles that look like little blisters because once you open them and they are exposed to any kind of bacteria the tears themselves are a very good environment for things. to grow. If you have something in there, normally if it’s a preservative-free product, you’re going to throw it away after you’ve used it, so [that contamination] has no importance.
The drops here [in the latest cases]- they just took an ordinary bottle without any kind of safety mechanism to prevent anything from going into that bottle. If it says “Preservative Free”, the bottle must indeed be a single bottle, or the bottle must look very strange and be a bit awkward as it will need to have a way of keeping it clean.
While those eye drops themselves were the problem, often patients don’t have the best sterile technique. You don’t wanna touch [the bottle’s tip] with your hand. You don’t want to touch it on your skin. You don’t want to touch it with your eyelashes, because any bacteria that can get into it can then grow in the eye drop bottle, and then you can get a much worse infection. This infection… has been traced back to the actual production of these drops. But eye drops can be contaminated from other outside sources, which raises this important safety point.
What are the signs of an infection and what should someone do if they have these symptoms?
Pseudomonas is a very fast growing organism. [At the beginning, an infected eye will be] a little red, a little itchy – often the eye will feel irritated or gritty. Contact lens wearers will sometimes think they have something on their contact lenses. This will take about a day or two, then the vision will become quite blurry fairly quickly, and the eye will become red and sore. Sometimes, if you look in the mirror, you will even see a creamy white or yellowish dot on the cornea, which is the clear part of the eye. [Infections] can develop quite quickly, and even within a few days, they can lead to thinning of the cornea, as the infection essentially takes hold of healthy tissue. And in some scenarios, they can even lead to corneal perforation.
Make an appointment with your ophthalmologist as soon as possible. Eye infections are quite common, and the sooner they are seen and treated, the better. Usually, if we catch things early, within a few days, we can deal with them very successfully.
How do we treat P. aeruginosa usually works?
It is quite common and is one of the most aggressive infections. Normally it is quite sensitive to many different antibiotics. The good thing is that it gets worse very quickly, but also usually responds to treatment very, very quickly. Usually, even within a day or two of starting proper treatment, patients will notice improvement.