Last year, a 72-year-old woman contracted an infection from a highly drug-resistant bacterium that had never been reported in the United States before. While her doctors initially believed that it "was just some sort of freak accident," the real culprit ended up being "a global manufacturing issue."

A woman develops a strange eye infection

In November, Nancy Montz, a 72-year-old woman from Ohio, woke up with yellow discharge on her pillow. Her left eye was also cloudy, and she had difficulty seeing out of it.

According to Montz, her eye was "real funky looking," but because of a prior health problem that numbed the left side of her face, she could not tell if there was any pain or soreness in the eye.

Initially, she went to an outpatient eye clinic for help with her blurry vision. From there, she was sent to the ED where ophthalmologists evaluated and diagnosed her with a corneal ulcer. Although the patient was prescribed antibiotics, her eye worsened over the next day, and she returned to the hospital to see a cornea specialist.

After culturing her infection, preliminary results showed that she had been infected by  Pseudomonas aeruginosa, a bacterium that is highly resistant to antibiotics. The patient was admitted to the hospital, and her case was referred to microbiologists and infectious disease experts.

According to Morgan Morelli, chief fellow in the division of infectious diseases and HIV medicine at the  University Hospitals Cleveland Medical Center, she had never seen this kind of bacteria in the eye before. In addition, P. aeruginosa  had never been reported in the United States before this.

"We were racking our heads to figure out how this happened," Morelli said. Notably, Montz did not wear contacts and had not been swimming recently, both of which are common ways for bacteria to enter the eye. "We wondered if she'd accidentally touched something, or there was some freak accident."

Ultimately, the team determined that the bacteria that infected Montz's eye likely came from a bottle of artificial tear eye drops she had been using. A lab identified a P. aeruginosa  isolate from Montz that matched genetic material in the tear drops she had been using.

"She probably scratched the left eye with the eyedropper accidentally and didn't realize it because she had no feeling," Morelli said. "That allowed the infection to enter the eye much more easily and quickly in that eye before it ever affected the right one."

"It required a lot of thinking and digging to figure out what was going on," she added. "And we never thought it was related to a global manufacturing issue."

Montz was treated with several antibiotics, including cefiderocol and two other topical antibiotics. Since then, her injury has improved, but it's unclear whether she will ever regain total vision in the affected eye.  

A recall of the contaminated eyedrops

In February, CDC and FDA  issued  alerts advising people to stop using several brands of artificial tear drops, including  EzriCare Artificial Tears, following reports of an outbreak of  P. aeruginosa. While those affected by the outbreak reported using more than 10 brands of artificial tears, EzriCare Artificial Tears was the most common brand.

As of March 14, at least 68 people in 16 states have been diagnosed with eye infections from the bacteria. Of these patients, eight, including Montz, have lost vision in at least one eye, four have had to have their eyeballs surgically removed, and three have died.

According to CDC, more cases will likely be identified in the coming weeks, and the agency will continue to update its investigation into the cases.

Although the contaminated products can no longer be purchased, Morelli said that they still pose a risk to consumers, particularly those who may not be aware of the recall. "People may still have it on their medicine cabinet shelves," she said.

To reduce the risk of any type of eye infection, Morelli offered several tips for using eye drops safely:

• Thoroughly wash your hands before removing the top of the bottle
• Avoid touching the tip of the dropper with your fingers or allowing it to come into contact with any other surfaces to ensure it stays as sterile as possible
• Don't use refillable eyedrop bottles
• Throw away any expired products
• Only use eyedrops that your doctor recommends

(Edwards, NBC News, 5/11; American Society for Microbiology press release, 5/11; Morelli et al., Antimicrobial Agents and Chemotherapy, 5/11)