Why Is the Bacteria in Eye Drops Spreading to People Who’ve Never Used Them?

The bacteria responsible for the EzriCare eye drop recall may be able to spread from person to person, according to the Centers for Disease Control and Prevention (CDC).

A CDC investigation identified patients who were infected with the bacteria, called Pseudomonas aeruginosa , but did not report or recall using artificial tears, Martha Sharan, spokesperson for CDC’s Division of Healthcare Quality Promotion, told Verywell in an email. 

"Though these patients may not have remembered using artificial tears, some of them have been identified in facilities with clusters (i.e., facilities with multiple colonized or infected individuals), suggesting potential secondary transmission from person to person," Sharan said. 

She added several patients linked to this outbreak did not show any signs or symptoms of clinical infection and were identified by colonization screening. These cases were also commonly discovered in healthcare settings and facilities with multiple infections.  

“To date, colonized case-patients have only been identified at inpatient healthcare facilities with infected individuals,” Sharan said. 

As of March 21, the CDC has identified at least 68 patients in 16 states who have been infected with this bacteria. There have also been three deaths, eight cases of vision loss, four reports of surgical eye removals, and a dozen of infections, according to a CDC report.

Here’s what experts say you need to know about the drug-resistant bacteria and how you can prevent the spread. 

How Does the Drug-Resistant Bacteria Spread? 

One of the main ways the Pseudomonas aeruginosa bacteria can spread is by direct contact with someone who is already infected, Benjamin Bert, MD, an ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, told Verywell.

"If there is someone with an eye infection and you touch the eye, you have the contaminant or the pathologic entity on your hands,” Bert said. "If you touch your own eye, you can spread the bacteria to yourself."

But you're probably not touching a lot of people's eyeballs. Bert adds that the bacteria can also spread when you into contact with contaminated products or items—including eye drop bottles, pillowcases, towels, or makeup products used by an infected person. 

It's also possible—though unlikely—to pick up Pseudomonas aeruginosa by making contact with a contaminated surface after an infected person rubs their eyes and touches something.

"With viral pink eye, someone can touch their eye, touch a doorknob—and then hours later, someone can come touch that same doorknob and touch their eye, and they’ll get infected with the virus,” Bert said. "That doesn’t happen with bacteria. Bacteria die off within a few hours."

What Happens If You Come in Contact With the Eye Drop Bacteria? 

Many people may experience no symptoms at all if infected second-hand with Pseudomonas aeruginosa. But there is a possibility they they will experience similar symptoms to someone who was initially infected, Bert said. Some reactions may include:

• Redness of the eye
• Eye discharge
• Eye soreness
• Eye irritation
• Eye pain
• Sensitivity to light
• Decreased vision

"Their course could be very similar to the person who was initially infected," Bert said. "If someone in your house has a red eye for any reason and you contract a red eye as well, you would be expected to have the same pathogen. You should initiate treatment for yourself as early as possible."

Sharan said some individuals who are exposed to the bacteria may become asymptomatically infected and may serve as a source of spread to others. This type of transmission typically occurs in inpatient healthcare settings. 

Who Is Most At-Risk?

In general, people who are admitted to healthcare facilities have the highest risk of acquiring this bacterial infection via person-to-person spread, though the overall risk is still low.

"Higher-risk individuals, such as those with serious underlying medical conditions or with indwelling devices (e.g., ventilators, catheters, and feeding tubes), are at greater risk of developing a clinical infection," Sharan said. "Case-patients that are part of this outbreak have been identified at acute care hospitals, long-term care facilities, emergency departments, urgent care clinics, and other outpatient clinics across 16 states," she said.

Patients in nursing homes or assisted living facilities are also at a higher risk of infection because they often require direct contact and care from multiple staff members, Bert said. This means staff members and caregivers in these settings share the same risk.

"Based on how resistant the bacteria is, if hand hygiene protocols are not followed to the exact needed level, spread is more likely in these environments than in other less populated environments," Bert said. "But the contact needs to be quite close and direct for it to spread. So if you’re not using eye drops and you’re not around someone who has this infection, the chances of getting it are very, very low."

If you are exposed to this bacteria outside of a healthcare setting but are otherwise a healthy individual, Sharan said the risk of developing a clinical infection is small.

"Most people who come into contact with this bacteria will not develop any symptoms related to it," she said.

How to Prevent the Spread of Bacteria 

To prevent Pseudomonas aeruginosa from spreading, experts recommend:

• Washing your hands with soap and water regularly
• Using latex or non-latex medical-grade gloves if you need to administer drops to someone else
• pillowcases, eye drop bottles, towels, and makeup products. 
• Washing any items that may have been contaminated, such as pillowcases, blankets, and towels
• Cleaning shared surfaces like door handles and countertops with disinfectants
• Avoid sharing personal items that may come in contact with the eye or face, including pillows

"Any time that someone has a red eye for any reason, assume it’s an infection first and take all precautions," Bert said. "It’s much better to overdo it than to deal with a second infection in the household."