Eye drops contaminated with a rare bacteria have led to the deaths of three people in the US, and resulted in another eight losing their vision and four having their eyeballs surgically removed.
Last week, the US Centres Centres for Disease Control (CDC) said 68 patients in 16 states had already been infected with this rare strain of Pseudomonas aeruginosa, reports the Daily Mail.
Among those who used the bacteria-laced Artificial Tears Lubricant eye drops, four patients had to have their eyeballs removed as a result.
The recalled drops were manufactured by Global Pharma Healthcare (GPH) in India, where the bacteria Pseudomonas aeruginosa is commonly linked to outbreaks in hospitals.
Last month, GGPH recalled its Artificial Tears drops, that were distributed by EzriCare and Delsam Pharma.
The product is usually for people suffering with dry eyes who need extra lubrication, and is sold at pharmacies in the US and on Amazon, though the products have since been pulled.
Health authorities are continuing to track infections as they investigate the outbreak in increased sensitivity to light and blurry vision, said the CDC.
Most of the cases have been linked to four regional clusters, with Ezricare drops being the only product used by patients in each of those groups.
The various patients reported using 10 different brands of artificial tears, but the preservative-free, over-the-counter EzriCare Artificial Tears was the brand most commonly reported.
It can spread through contaminated hands or medical equipment.
The outbreak is considered particularly worrisome because the bacteria driving it is resistant to standard antibiotics.
Two case studies published in JAMA reported that in one instance, a 72-year-old woman lost vision in her left eye after using EzriCare drops for about a week.
“She started noticing some blurry vision in her left eye for a few days,” said Dr Ahmed Omar, an ophthalmologist at University Hospitals Cleveland Medical Centre. “It was initially painless, but the patient said one morning she woke up with a yellow discharge on her pillow.
“That’s when she started noticing that the appearance of her eye had changed.”
Another case study involved a 72-year-old man who developing significant vision loss from an infection of the cornea. It later improved, but he still has vision issues.
He had not experienced previous eye problems but after using EzriCare artificial tears for eye dryness, he had severe pain and went to the Bascom Palmer Eye Institute in Miami where it was discovered he had multidrug-resistant Pseudomonas aeruginosa keratitis.
“When we examined his right eye, there was a severe corneal infection,” said Dr Marissa Shoji. “He could only see shadows and was not able to see letters, due to the extent of the ulcer.”
Doctors started the man on strong antibiotics, but he only got worse.
“We typically expect some degree of improvement with these medications, but when we saw him two day later, he was getting far worse,” she said.
“So that’s when we inquired about specifically the EzriCare tears, because we knew they were associated with resistant infection that may not respond to those really strong antibiotics.”
They discovered that cultures from the man’s cornea and EzriCare bottle grew the same strain of multidrug-resistant Pseudomonas.
At his two-month follow-up, his vision was 20/400, meaning he can see at 20 feet what healthy people can see at 400 feet.
“At some point, he was in danger of having permanent vision loss,” said Dr Guillermo Amescua, an ophthalmologist at Bascom Palmer Eye Institute.
“He now has what is called corneal blindness because he’s 20/400 and has a corneal scar, but with corneal transplantation, he might have a better prognosis.”
In January, after learning about the CDC’s investigation of Pseudomonas infections, EzriCare said in a statement that it 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 continued use of the product.”
Study details
Pseudomonas aeruginosa Corneal Ulcer Associated With Artificial Tears Eye Drops
Morgan Morelli, Amy Kloosterboer, Ahmed F. Omar.
Published in JAMA Network on 22 March 2023
Abstract
A 72-year-old woman presented with vision loss in the left eye for 1 week. She reported use of over-the-counter (OTC) multiuse eye drops for bilateral dry eye syndrome. Physical examination was notable for visual acuity of light perception (LP) and a hypopyon filling the anterior chamber (Figure, A) with an epithelial defect (Figure, B) involving most of the cornea. Examination of the right eye was unremarkable. Culture of left corneal scrapings grew extensively drug-resistant Pseudomonas aeruginosa, susceptible only to cefiderocol. Culture of her OTC EzriCare artificial tears grew comparable drug-resistant P aeruginosa. She was treated with intravenous cefiderocol, topical imipenem/cilistatin, and topical polymyxin B/trimethroprim. Her course was complicated by a serous choroidal detachment detected by B-scan ultrasonography. At 2-month follow up, left-sided vision remained LP. On February 1, 2023, the US Centers for Disease Control and Prevention issued a health advisory1 regarding more than 50 similar infections associated with OTC
JAMA Network comment – Potential Rare Danger of Presumably Benign Artificial Tears
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