TAMPA, Fla. (WFLA) — An outbreak linked to recalled eye drops has infected 81 people in Florida and in 18 other states, according to a recent update from the Centers for Disease Control and Prevention.

The CDC said it is investigating the strain of Pseudomonas aeruginosa. Health officials said the strain, called VIM-GES-CRPA, had never been reported in the United States prior to the outbreak.

It has been reported in California, Colorado, Connecticut, Delaware, Florida, Illinois, North Carolina, New Jersey, New Mexico, Nevada, New York, Ohio, Pennsylvania, South Dakota, Texas, Utah, Washington and Wisconsin.

Four deaths have been linked to the drug-resistant bacterial infection traced to the contaminated eye drops.

“Most patients reported using artificial tears,” the CDC said. “Patients reported over 10 different brands of artificial tears and some patients used multiple brands. EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles, was the brand most commonly reported. This was the only common artificial tears product identified across the four healthcare facility clusters.”

Researchers said opened bottles of EzriCare Artificial Tears from multiple lots contained the VIM-GES-CRPA strain. These bottles were taken from infected and uninfected people in two different states.

The CDC said it is still testing unopened bottles to see if they were contaminated during manufacturing.

So far, 14 people have lost vision and four people had to have their eyeballs surgically removed, the CDC said.

The CDC recommends clinicians and patients stop using EzriCare or Delsam Pharma’s Artificial Tears products.

The Food and Drug Administration said both products have been recalled. It put out separate warnings for customers to immediately stop using the products.

According to health officials, those who have used EzriCare or Delsam Pharma’s artificial tears and have signs or symptoms of an eye infection should seek medical care immediately.

According to the CDC, eye infection symptoms may include:

  • Yellow, green, or clear discharge from the eye.
  • Eye pain or discomfort.
  • Redness of the eye or eyelid.
  • Feeling of something in your eye (foreign body sensation).
  • Increased sensitivity to light.
  • Blurry vision.

“At this time, there is no recommendation for testing of patients who have used this product and who are not experiencing any signs or symptoms of infection,” the CDC said.