Poison in eye drops puts some kids in a coma - FDA issues a safety warning

The United States Food and Drug Administration (FDA) has issued a warning about over-the-counter eye drops.

The danger is that children may accidentally swallow the eye drops.  The drops in question are used to relieve redness in the eyes and they include the popular Visine brand of drops.  

Keep in mind that there are safer and more effective alternatives available on the advice of your optometrist.  In fact, at our Vancouver clinic, we almost never recommend these drops because of their danger and because they only "get the red out" of your eyes by narrowing blood vessels, which does not treat the cause of the redness and ignores the fact that there is a biological reason why  blood vessels are so visible in your eyes in the first place and it is that reason that needs to be addressed if the condition is to be properly treated.  

The eye drops can be dangerous because they contain the active ingredients tetrahydrozoline, oxymetazoline, or naphazoline. These same ingredients are also found in some nasal sprays.  These products are sold under various brand names, as generics, and as store brands (see List of Products created by the FDA below).

The FDA reviewed 96 cases of accidental swallowing in  children 5 years of age and younger. There were no deaths but swallowing had serious consequences requiring hospitalization such as:

• coma,
• decreased heart rate, 
• decreased breathing, and 
• sedation (sleepiness) 

These serious conditions have occurred on the swallowing of  only a small amount (1-2 mL; for reference, there are 5 mL in a teaspoon) of the eye drops. Most of these redness-relief eye drops  do not currently come packaged with child-resistant closures, so children can accidentally ingest the drug if the bottles are within easy reach.

Consumers should store these products out of reach of children at all times. If a child accidentally swallows these eye drops  and seek emergency medical care immediately.

List of Products*

Products containing tetrahydrozoline	Products containing naphazoline	Products containing oxymetazoline
Visine Original	Visine A	Visine L.R.
Visine A.C.	Ak-Con Ophthalmic Solution	12 Hour Nasal Decongestant Nasal Spray
Visine Advanced Relief	Napha Forte Ophthalmic Solution	Afrin Extra Moisturizing Nasal Spray
Visine Totality	Naphazoline HCl Ophthalmic Solution	Afrin No Drip Severe Congestion Nasal Spray
Visine Maximum Redness Relief Formula	All Clear Ophthalmic Solution	Afrin No Drip Sinus Nasal Spray
Walgreens Redness Reliever Advanced Eye Ophthalmic Solution	All Clear AR Maximum Strength Ophthalmic Solution	Afrin No Drip Sinus Extra Moisturizing Nasal Spray
Tyzine Nasal Spray	Opcon-A Ophthalmic Solution	Afrin Original Nasal Spray
GNP Original Eye Drops	Naphcon A Ophthalmic Solution	Afrin Severe Congestion Nasal Spray
Opti-clear Ophthalmic Solution	Walgreens Eye Allergy Relief Drops	Dristan 12 Hour Nasal Spray
Tetrahydrozoline HCl Ophthalmic Solution		Equaline 12 Hour Nasal Spray
Today’s Health Original Eye Drops		Equaline 12 Hour Extra Moisturizing Nasal Spray
Leader Eye Drops Regular Formula Ophthalmic Solution		Equate Nasal Spray
		GNP 12 Hour Nasal Spray
		GNP 12 Hour No Drip Nasal Spray
		GoodSense 12 Hour Nasal Spray
		Leader 12 Hour Nasal Spray
		Maximum Strength Nasal Decongestant Nasal Spray
		Mucinex Full Force Nasal Spray
		Mucinex Moisture Nasal Spray
		Nasal Relief Spray
		Neo-Synephrine 12 Hour Nasal Spray
		Publix Nasal Spray
		Select Brand Nasal Spray
		Sinex Nasal Spray
		Sudafed OM Nasal Spray
		Today’s Health Nasal Relief Nasal Spray
		Tope Care 12 Hour Nasal Spray
		Walgreens Anefrin Nasal Spray

*List may not be all-inclusive. Check the Drug Facts label on the package to determine the active ingredients of any over-the-counter product.

References

1. Spiller HA, Rogers J, Sawyer TS. Drug facilitated sexual assault using an over-the-counter ocular solution containing tetrahydrozoline (Visine®). Legal Medicine 2007;9:192-5.
2. Katar S, Taskesen M, Okur N. Naloxone use in a newborn with apnea due to tetrahydrozoline intoxication. Pediatr Int 2010;52:488-9.
3. Tobias JD. Central nervous system depression following accidental ingestion of Visine eye drops. Clin Pediatr (Phila). 1996;35:539-40.