EzriCare Eye Drops Recalled as CDC Investigates Link to Drug-Resistant Bacterial Infections

The Centers for Disease Control and Prevention are urging people to stop using EzriCare Artificial Tears after the eye drops were linked to a drug-resistant bacterial strain resulting in hospitalizations, multiple cases of vision loss, and one death, the agency said Wednesday.

As of January 31, the CDC had identified 55 patients across 12 states with a rare and “extensively drug-resistant” strain of the bacteria Pseudomonas aeruginosa, which had never before been reported in the United States. Most patients had used artificial tears—most commonly, EzriCare Artificial Tears, a preservative-free, over-the-counter product.

This strain of bacteria is resistant to a class of antibiotics known as carbapenems, which are typically reserved for the most serious infections, and are often considered a last resort treatment.

On Thursday, the manufacturer of the eye drops voluntarily recalled the product—along with Delsam Pharma’s artificial tears product—due to a possible contamination, as the CDC and FDA continue to investigate the cluster of bacterial infections.

“As of today, we are not aware of any testing that definitively links the Pseudomonas aeruginosa outbreak to EzriCare Artificial Tears,” the company wrote in a statement on Wednesday. “Nonetheless, we immediately took action to stop any further distribution or sale of EzriCare Artificial Tears.”

Here’s what eye drop users should know about their risk of infection, and the symptoms people who have recently used the eye drops should be aware of.

What Is Pseudomonas aeruginosa?

This specific strain of bacteria—carbapenem-resistant Pseudomonas aeruginosa with Verona integron-mediated metallo-β-lactamase and Guiana-extended spectrum-β-lactamase (VIM-GES-CRPA)—had never previously been reported in the U.S., but the bacterium itself is not entirely unknown.

“This pathogen that we’re talking about, Pseudomonas aeruginosa, is a bacteria that is not uncommonly involved in serious corneal infections,” Brooke Harkness, OD, assistant professor of ophthalmology at the Oregon Health and Science University Casey Eye Institute, told Health. “But it’s usually found just in the environment, so in water and soil.”

It can become a serious issue when it gets into the body. The bacteria has been known to cause infections of the lungs, blood, or in other parts of the body after surgery. For the eyes specifically, people who wear contact lenses—especially people who sleep in them or rinse them with tap water—are at risk of bacterial infections such as these, Dr. Harkness added.

And these bacterial infections are almost always quite serious, said James D. Reynolds, MD, professor and chair of the Ross Eye Institute and department of ophthalmology at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences.

“They tend to be very virulent organisms, and therefore [are] very effective at attacking human tissue,” Dr. Reynolds told Health. “[People] always end up with a significant scar, even if you’re able to cure the disease. And that scar, of course, will cause significant reduced vision and may require corneal transplantation. So Pseudomonas is a bad bug.”

Once it’s in the eye, Dr. Reynolds explained, the Pseudomonas releases a specific type of enzyme that allows it to break down chemical bonds in the eye and penetrate the conjunctiva and then the cornea, resulting in a loss of vision in some capacity.

Treating this type of bacterial infection can be extremely difficult. In addition to being resistant to the antibiotic carbapenem, it’s resistant to multiple other antibiotics, as well.

What Are the Symptoms of an Eye Infection?

The CDC has linked this outbreak to multiple types of infections, including eye infections, respiratory infections, urinary tract infections, and sepsis.

The agency is urging people who have used EzriCare Artificial Tears to be aware of any signs or symptoms of an eye infection and to seek medical care immediately so they can be tested for the bacterial infection.

The symptoms most commonly associated with eye infections include:

• Yellow, green, or clear discharge from the eye
• Eye pain or discomfort
• Redness of the eye or eyelid
• Feeling like something is in the eye
• Increased sensitivity to light
• Blurry vision

However, the CDC is not recommending that patients who have used this product but aren’t experiencing any symptoms of eye infection get tested.

Should You Be Concerned About Using Preservative-Free Eye Drops?

CDC lab testing on opened bottles of EzriCare Artificial Tears identified the presence of the bacteria that matched the strain found in infected people. The bottles were collected from patients with and without eye infections, and could mean the eye drop bottles were infected during use or during the manufacturing stage.

Currently, the CDC is testing unopened bottles of the eye drops to help narrow down at what point the bacteria could have ended up contaminating the products.

Regardless of how the Pseudomonas aeruginosa got into the artificial tears solution, the fact that the EzriCare product is reportedly preservative-free likely played a role in helping it grow and spread, experts said.

When these types of eye solutions don’t have preservatives, it usually means that they have a shorter shelf life and it will take less time for them to start to grow bacteria as compared to eye solutions with preservatives, said Michael Wildes, MD, clinical director for the UCHealth Sue Anschutz-Rodgers Eye Center and ophthalmologist at the University of Colorado Anschutz Medical Campus.

People who may be more susceptible to infections—such as those who wear contact lenses, those who are immunocompromised, or those who have some sort of eye disease or injury—can start to see infections from their eye drops if the lack of preservatives is allowing bacteria to grow, he added. 

Preservative-free eye drops are not inherently bad—in fact, they can be useful for people who have allergies in particular, Dr. Reynolds explained. But they need to have additional protection in the packaging.

“It needs to somehow otherwise be protected against contamination,” Dr. Harkness said. “That typically would be either by packaging in very small doses—single-use dose vials—or in a special bottle that has a one way valve and a filter to protect the bottle from being contaminated.”

The CDC pointed out that the EzriCare products were packaged in multi-dose bottles.

How to Practice Proper Eye Hygiene

Though Pseudomonas aeruginosa infections can be quite serious, experts say that the best thing to do to prevent them, along with other eye infections, is to stay committed to using best practices when dealing with eye drops or contacts. 

"If people find bottles that they have of this particular brand, then dispose of them immediately,” Dr. Harkness said. “[But] we never have a way of knowing when this will occur, [so] practicing good hygiene with contact lenses is extremely important.” 

That means washing hands before touching contacts, avoiding rinsing contact lenses, cases, or eyes with tap water, and making sure to get rid of eye drops and other eye products after they expire or after 90 days, she said. 

People should also consider seeking out medical care earlier rather than later if they suspect they might have an infection, Dr. Reynolds explained. Symptoms such as redness in the eye, eye discomfort or pain, and discharge from the eye may all seem like pink eye when it’s really another, more dangerous type of Pseudomonas bacterial infection, he said.

Besides being a reminder to commit to those hygiene practices, the CDC’s investigation shouldn’t be a reason to ditch other brands eye drops or artificial lenses. Although infected patients reported using over 10 different brands of artificial tears, the CDC has not named or voiced any concerns about brands other than EzriCare.

“In general, this is a fairly uncommon thing,” Dr. Wildes said. “We don’t have any concerns about using other brands of artificial tears, whether they’re preservative free or not.”

But it’s also a good idea for people to check in with their doctors to make sure that they’re using the best types of artificial tears or eye drops that they can be, whether that be with or without preservatives.

“People definitely should not overreact to this if they are artificial tear users,” Dr. Reynolds said. “But every patient—with every eye drop—should practice sterile technique.”