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Eye drops that have been contaminated with a highly drug-resistant strain of bacteria have now been linked to four deaths and 14 cases of blindness, according to an update from the Centers for Disease Control and Prevention (CDC). 

The CDC said in a post on its website that it has identified 81 patients from 18 states who have been infected with VIM-GES-CRPA, a rare strain of a drug-resistant bacterium called P. aeruginosa. This includes 13 additional patients from the agency’s previous update in March. 

Six of the cases had specimens of the bacteria that were collected before the affected products were recalled in early February, but the cases were not confirmed until more recently because of the time needed to confirm the outbreak strain and retrospective reporting of infections. 

The number deceased rose from three to four from the CDC’s last update, while the number blinded rose from eight to 14. An additional four patients beyond the 14 who experienced vision loss needed to have an eyeball surgically removed. 

The release states that most of the patients infected with the bacteria reported using artificial tears, with more than 10 different brands being named. The most commonly reported brand was EzriCare Artificial Tears, an over-the-counter product that is packaged in multidose bottles. 

EzriCare was the only product identified in four health care facility clusters, according to the release. 

Manufacturer Global Pharma has voluntarily recalled three of its products — EzriCare Artificial Tears, Delsam Pharma Artificial Tears, and Delsam Pharma Artificial Ointment — in connection with the outbreak, and no additional products have been linked to it. 

The CDC warned that the public should stop using these products until they receive additional guidance from the agency or the Food and Drug Administration. It said symptoms of an eye infection can include yellow, green or clear discharge, eye pain or discomfort, eye or eyelid redness, feeling that an object is in the eye, increased light sensitivity and blurred vision.