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Pseudomonas aeruginosa Corneal Ulcer Associated With Artificial Tears Eye Drops

To identify the key insights or developments described in this article
1 Credit CME

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 artificial tears.

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Article Information

Published Online: March 22, 2023. doi:10.1001/jamaophthalmol.2023.1105

Corresponding Author: Ahmed F. Omar, MD, University Hospitals Eye Institute and the Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106 (ahmed.omar@uhhospitals.org).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

Reference
1.
Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears | HAI | CDC. https://www.cdc.gov/hai/outbreaks/crpa-artificial-tears.html (accessed March 6, 2023).
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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