What is the difference between regular eye drops and preservative-free products?

Many eye drop brands contain chemical preservatives such as benzalkonium chloride, or BAK, as well as other ingredients. Preservative-free products such as Purely Soothing contain mostly saline and distilled water. EzriCare doesn’t include BAK or any other preservative.

Should consumers avoid preservative-free products?

Casual users tend to use bottled preserved tears that use benzalkonium chloride, or BAK, as a preservative. “Non-preserved products don’t have that protection and are in danger of being contaminated,” said Dave Patel, an ophthalmologist at the Mayo Clinic in Phoenix. Those with severe or poorly controlled dry-eye symptoms, or who have had surgery or other illnesses, however, require chronic moisture and may be advised to use preservative-free products to avoid the cumulative toxic effects of BAK, Patel said. “Using it once or twice a day, is not detrimental to the eye,” he said. “But if you use it six to eight times a day for years, it builds toxicity and irritates the eyes.” Purely Soothing was voluntarily recalled by the manufacturer over concerns that it may not be sterile, and that, Patel said, indicates a problem with the process of making the product sterile rather than a problem with the stability of the product.

How can you protect yourself if you must use a preservative-free solution?

Preservative-free artificial tears come in both multiuse bottles and single-use vials. The safest approach to prevent infection is to stick to single-use products, experts said. “Consumers do not need to fear or avoid preservative-free drops,” said Jeffrey H. Ma, an ocular surface disease specialist at the University of California at Davis Eye Center in Sacramento and assistant professor of ophthalmology at the University of California at Davis School of Medicine. “They are a great option for dry eyes, as they tend to be more gentle on the eyes and can be used more frequently throughout the day.” Infection risk from preservative-free drops is “extremely low when used correctly,” he said. People should not touch the tip of the vial to their eyes or keep a vial for more than a day, referring to those who try to get more than one dose from the small containers. Wash your hands before using any eye products, said Stuart H. Cohen, chief of the infectious diseases division of UC Davis Health. And if there is a dropper, do not touch your eye directly with it. Cohen also urged consumers to not make their own artificial tears solutions.

What are the symptoms of an eye infection?

It may be difficult for people to distinguish between a potentially serious eye infection and other less threatening conditions, since the symptoms often are similar, experts said. Signs of infection may include a yellow, green or clear discharge from the eye; eye pain or discomfort; redness; the feeling that something — such as a foreign body — is in the eye; increased sensitivity to light; and blurry vision. Other conditions, however, can also cause these same symptoms, “including dry eye disease and various autoimmune or inflammatory diseases of the eye,” Ma said. “In general, if symptoms do not improve with artificial tears or are getting worse, one should seek medical care.” It’s important to seek professional help since people cannot determine on their own whether it’s an infection, Patel said. “If it is truly bacterial, a direct eye exam will determine it, since there are certain clinical features we can see that would suggest bacteria and the degree of infection,” he said.

How are eye infections treated?

Nonresistant bacterial infections will respond to antibiotic drops, experts said. They should never be used against viral eye infections such as conjunctivitis, also known as pinkeye. Viral infections do not respond to antibiotics and using them against viruses contributes to the development of resistance. Resistant bacterial infections are difficult — sometimes impossible — to treat. Eye-care professionals may try stronger, “off-label” medications, in some urgent cases, although toxicity is a risk. “There also are ‘salvage’ surgeries to eradicate infection, but they are rare,” Patel said. Some infectious-disease experts see phage therapy as a promising strategy against the growing problem of resistant bacteria said Robert T. Schooley, distinguished professor of medicine in the division of infectious diseases and global public health at the University of California at San Diego and co-director of UC San Diego’s Center for Innovative Phage Applications and Therapeutics. The approach involves using viruses — which don’t make people sick — to target and destroy specific resistant bacteria. The Food and Drug Administration has not yet formally approved phage therapy, but allows phages to be used in research and in individual life-threatening cases. “Patients with highly resistant organisms like the one in these eye drops are ones for whom a phage intervention would be easy to justify,” Schooley said.

More eye drops are being recalled. Here’s what to know.

The latest recall is from Pharmedica, which urged consumers to stop using Purely Soothing, 15% MSM Drops because of non-sterility

By Marlene Cimons

Updated March 7, 2023 at 5:49 p.m. EST|Published February 2, 2023 at 3:06 p.m. EST

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6 min

The Food and Drug Administration on Tuesday posted news of a second recall of eye drops in less than two months. Millions of Americans use eye drops for conditions such as dry eye, glaucoma and itchiness caused by allergies or air pollution.

The latest recall of Purely Soothing, 15% MSM Drops is because of concerns that the product may not be sterile. Contaminated eyedrops, the FDA said, are linked to the risk of eye infections that may cause blindness.

The eye drops are used as an anti-inflammatory to help with eye irritation or swelling. There have been no reports of illness related to this product, Pharmedica said announcing the voluntary recall.

In February, the Centers for Disease Control and Prevention urged consumers to stop using EzriCare Artificial Tears, an over-the-counter preservative-free product and the prime suspect in an outbreak of serious bacterial infections. The CDC identified 55 cases of infection in 12 states, with at least five of them resulting in permanent vision loss and at least one death. The manufacturer, Global Pharma Healthcare, initiated a voluntary recall of the product.

“Eye infections are always an obvious concern as severe complications including permanent vision loss can result,” Paul Volberding, professor emeritus of epidemiology and biostatistics at the University of California San Francisco School of Medicine, said in early February when EzriCare was recalled.

How concerned should eye drops users be about their risk of infection? We asked eye experts and infectious-disease specialists. Here’s what they advised.

More eye drops are being recalled. Here’s what to know.

The latest recall is from Pharmedica, which urged consumers to stop using Purely Soothing, 15% MSM Drops because of non-sterility

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