Saturday, October 27, 2012

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.
  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.