Risks of Eye Drops Might Be Overlooked, Experts Question Safety and Efficacy

Recent recalls shine light on issues with eye drops. As questions emerge about eye drops’ effectiveness, some urge a more holistic approach to eye health.

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Risks of Eye Drops Might Be Overlooked, Experts Question Safety and Efficacy — (Rohane Hamilton/Shutterstock)

By Vance Voetberg

12/17/2023

Updated:

12/17/2023

0:00

Blink, and you may have missed it: the recent commotion over America’s favorite eye drops.

Over the past year, common over-the-counter (OTC) ocular potions have undergone a PR crisis of epic proportions: contaminated batches, government warnings, and recalls.

But amidst the explosive media hullabaloo lies a deeper debate: Do eye drops even work? Or do they provide only surface-level relief while ignoring the true roots of ocular distress?

FDA Warns Against Almost 30 Major Brands of Eye Drops

As of mid-November, the U.S. Food and Drug Administration (FDA) has listed nearly 30 OTC eye care products that should be avoided due to contamination. Sold at major retailers like Rite Aid and Target, these products can cause “partial vision loss or blindness.” The brands the FDA warns against due to the risk of an eye infection include the following:

CVS Health.
Leader (Cardinal Health).
Rugby (Cardinal Health).
Rite Aid.
Target Up & Up.
Velocity Pharma.

The FDA found unsanitary conditions and bacteria at the manufacturing facilities for these brands of products. OTC eye care products “pose a potential heightened risk of harm to users because drugs applied to the eyes bypass some of the body’s natural defenses,” according to the FDA.

Several of the recalled eye care products were generics, Dr. Danielle Richardson, a holistic optometrist, told The Epoch Times. “I always recommend patients use brand-name eye drops because there is consistency among the quality, including preservatives used and manufacturing processes,” she said. While not immune to recalls, name brands are less variable than generics.

Risks of Eye Drops Downplayed

“Often, people don’t consider over-the-counter eye drops as having any potential for harm,” Dr. Timothy Janetos, assistant professor of ophthalmology at Northwestern University, told The Epoch Times. “However, we have seen with the recent warning letters that contaminated drops can lead to serious infections and even rarely death,” he said.

Even though such serious issues are rare given the massive size of the artificial tear market, it’s still vital to recognize these products do carry risks and are not entirely harmless, Dr. Janetos noted.

Calls for Stricter Regulation

The recent recalls stem from a lack of FDA oversight, according to a recent paper co-authored by Dr. Janetos and published in JAMA Ophthalmology. Although the FDA provides manufacturing guidelines, implementation is left to the companies themselves, he added. The FDA only makes sporadic inspections.

“Clearly, this system has let multiple products escape to the market that are potentially harmful,” he added.

Getting to the Root of the Problem

OTC eye drops often fail to treat the underlying causes of eye irritation and dryness, according to Dr. Richardson.

“Eye drops can help alleviate symptoms, but the goal is to understand the underlying cause contributing to the symptoms and creating lifestyle solutions that eliminate the dependence on eye drops,” she said.

This may involve supplements to treat dryness, dietary changes to improve allergies, in-office procedures, and air purifiers and humidifiers to help with chronic redness.

Medication should be used only when necessary and with minimal preservatives while also addressing the whole of the patient’s needs, she added.

Widespread Dry Eye Disease

The most common use of eye drops is for dry eye disease, which impacts over 16 million American adults. This condition stems from disrupted tear duct homeostasis.

Contributing factors include screen use, medications, hormonal changes, poor diet, and smoking. Optometrists often prescribe artificial tears to reduce dry eye irritation.

However, some eye doctors and researchers believe relying on drops to treat dry eye disease is a superficial approach that ignores the root causes of dryness.

A 2019 report in Antibiotics suggests dry eye disease is an inflammatory autoimmune condition driven by dysregulated immune pathways. As demonstrated in a study on mice, restoring proper immune function is critical to reversing it.

Seeking the Source of Inflammation

Topical antibiotics and anti-inflammatories in eye drops represent the prevailing dry eye disease treatment paradigm. However, researchers in the Antibiotics report contend that “we need to move beyond merely keeping inflammation in check ... determining and ameliorating the source of inflammation” in treating dry eye disease.

Experts emphasize the link between dry eye disease, gut bacteria balance, and the ocular microbiome, which are microorganisms in the eye in clear tissue covering the white part of the eye. Antibiotics to treat dryness may disrupt healthy eye microbiomes.

A balanced community of good bacteria in the eyes plays a vital role in keeping the outer eye surface healthy. The use of antibiotic eye drops can disturb this balance, triggering inflammation. This can allow harmful microbes to multiply, disabling the eye’s immune protection. The result is problematic side effects from a defective eye defense system.

If doctors see dry eye disease as an autoimmune issue stemming from imbalanced microbiomes, they can draw from extensive research on similar chronic conditions, researchers have found.

Healthy Body, Healthy Eyes

Researchers believe cultivating a healthy microbiome through functional foods and probiotics could be the “holy grail” for treating dry eye disease. If it is an inflammatory disorder, lifestyle changes and anti-inflammatory medications could also help induce remission.

Our screen-heavy modern lives cause us to blink less, leading to dry, fatigued eyes, Dr. Richardson said. “Lifestyle habits like taking visual breaks and eating a diet rich in omega-3s can help patients be more comfortable during the day,” she added.

Blue-light-filtering computer glasses may also reduce eye strain, though some have questioned their effectiveness.

The eyes need the same vitamins and minerals as the rest of the body, Dr. Richardson noted. A nutrient-rich diet or quality multivitamins benefit ocular health.

“The key to true dry eye treatment is to identify the underlying cause with your eye doctor and create a custom treatment plan tailored to you,” she added.