Eye Drops: Treatment Options and Infection Risks

Eye drops come in variety of forms for various indications. Recently, the FDA recalled multiple brands of eye drops, including a brand that was linked to serious eye infections, vision loss, and a death. The recalls included Artificial Tears Lubricant Eye Drops distributed by EzriCare and Delsam Pharma, Brimonidine Tartrate Ophthalmic Solution 0.15% from Apotex Corporation, and Purely Soothing 15% MSM drops, from Pharmedica USA.

Artificial Tears was associated with severe eye infections in approximately 55 patients, causing specifically pseudomonas infections. Brimonidine was recalled for cracks discovered in the bottle caps and Purely Soothing was associated with non-sterility issues, as well as associated reports of infections.

Each of these eye drops had various lot numbers that were recalled, specifically. Artificial Eye Ointment was also recalled from Global Pharma Healthcare after it was linked to bacterial contamination; however, there were no reported infections to date.¹

The recent recalls affected patients across 12 different states, including California. The major recalls were issued due to the seriousness of illnesses and infections they were associated with, which include blindness. Those affected experienced symptoms such as blurry vision, discharge, pain in the eyes, redness of eyelid, and increased sensitivity to the light.¹

The use of eye drops has a history dating back 3500 years ago. In 1872, Georg Ebers, a German Egyptologist, discovered a collection of Egyptian medicinal recipes discussing eye pastes that included copper and manganese to help with their anti-infective properties.²

Eye drops come in many forms and for many indications, such as redness, itchiness, dryness, allergies, dilating drops, glaucoma drops, lubricants, numbing agents, antibiotics, and to lower pressure. Pain reliever eye drops may include non-steroidal anti-inflammatory agents, which could relieve eye pain, as well as corticosteroids and local anesthetics, which could help to numb the eyes. Some of these drops come as prescription only and some are available OTC.³

Many of these eye drops come with specific instructions for use, especially related to sterility, to prevent unwanted infections. Unless patients receive clear instructions on proper use by physicians and pharmacists, many may be using them incorrectly. Incorrect use could lead to underdosing of the patient or exacerbate the risk of infections and potentially worsening the conditions.³

Eye drops can be categorized mainly into 5 categories. The first group would include drops for dry eyes, which help with redness, itching, and irritation.

Constant exposure to dry and windy conditions may make people suffer from chronic dry eye syndrome. The OTC eye drops for dry eyes offer temporary relief to allow patients time to seek professional help if needed.

The second group includes drops that remove redness caused by allergies, contact lens irritations, and sheer eye fatigue, which may also cause redness in the eyes. Decongestant eye drops can help bring the swelling in the eyes down and lubricate the eye surface.⁴

The third group of drops include eye drops to help dilate the eyes, which are helpful in comprehensive exams that allow the ophthalmologist or optometrist to have a better and clearer view of the eye interior. Usually, the dilation effects start within 20 to 30 minutes and can last for few hours.

The fourth group of eye drops include those for glaucoma, which help to reduce pressure in the eyes. Some of these eye drops drain the fluid in the eyes regularly, and some reduce the amount of fluid produced in the eyes.

The fifth group includes drops used for injuries to the eye to help with swelling, redness, and damage to the affected eyes, which include anti-inflammatory and analgesic eye drops, as well as antibiotic types.⁴

Regardless of the drops used, there are a few processes that patients can follow to ensure safe use. These include the very important first step of washing hands thoroughly before eye drop use to ensure not transmitting any bacteria from the hands to the eyes. Every physician and every pharmacist should be reminding, re-reminding, and instructing patients to wash their hands with soup and water before every use. The other techniques include tilting the head back or in a position that the drops can easily go into and stay in the eyes.

The comfort level of the patient should also be assessed, because when they are not comfortable, patients may not get the correct amount of the drops. If too comfortable, patients may have the risk of rushing and not following the proper way of hand washing and sterility techniques.⁵

With the recent eye drop recalls, pharmacists should be on the lookout for news updates and stay informed about the recalled brands. Following the instructions for proper use and effective hygiene habits with every use in eye drop administration allow for patients to benefit the most from each dose.

References

1. Press, T.A. (2023) 2 more eyedrop brands are recalled due to risks of injury and Vision Problems, NPR. NPR. Available at: https://www.npr.org/2023/03/08/1161876495/eyedrops-recalled-purely-soothing-pharmedica-apotex. Accessed: April 7, 2023.

2. Mark B. Abelson, M.D. (2014) 3,500 years of artificial tears, Review of Ophthalmology. Available at: https://www.reviewofophthalmology.com/article/3500-years-of-artificial-tears. Accessed: April 7, 2023.

3. Eye drops (2022) American Academy of Ophthalmology. Available at: https://www.aao.org/eye-health/treatments/eye-drops-kinds-recommendations. Accessed: April 7, 2023.

4. 5 types of eye drops explained (no date) Calvert Ophthalmology Center. Available at: https://www.calverteyecenter.com/5-types-of-eye-drops-explained. Accessed: April 7, 2023.

5. How to put in Eye Drops (no date) National Eye Institute. U.S. Department of Health and Human Services. Available at: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/glaucoma-medicines/how-put-eye-drops. Accessed: April 7, 2023.