Four people have died from a rare strain of bacteria that can "melt" through eyeballs - after it was linked to contaminated eyedrops in the US.
The Centres for Disease Control and Prevention (CDC) confirmed the number of patients treated for the drug-resistant strain of Pseudomonas aeruginosa has now risen to 81 patients in 18 states, which is 13 more patients and two more states, according to a new update.
Infections have 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.
Patients had been advised to stop using using EzriCare or Delsam Pharma’s Artificial Tears products, which were made at an Indian factory, following several infection control failings.
A Food and Drug Administration investigation discovered Global Pharma's production process to be unsterile as dirty equipment had been found and safety protocols ignored.
One person had originally died death from an infection earlier this year and four patients were forced to have their eyeballs removed after suffering vision loss.
The CDS said in the report: "These cases were confirmed after the recall date due to the time it takes for testing to confirm the outbreak strain and because of retrospective reporting of infections."
The majority of cases were caused by contaminated eyedrops or artificial tears - with ten brands initially connected to the outbreak.
According to the CDC two of the brands, which were made in India and imported into the US, were scrapped from the shelves following the outbreak.
In January, the organisation urged the public to stop using EzriCare Artificial Tears and Delsam Pharma's Artificial Tears.
A month later, Global Pharma, which owns the brands, recalled the products after a formal recommendation from the Food and Drug Administration (FDA).
Opened bottles from patients were tested and shown to have contained the bacteria, which is resistant to antibiotics.
The CDC and FDA recommended patients and doctors stop using the products and for them to be discarded.
The EzriCare spokesperson said: "To the greatest extent possible, we have been contacting customers to advise them against continued use of the product.
"We also immediately reached out to both CDC and FDA and indicated our willingness to cooperate with any requests they have of us."
The Centres for Disease Control and Prevention said anyone who has used the recalled eyedrops or artificial tears should contact a doctor - if they are experiencing symptoms.
Some of the symptoms include yellow, green, or clear discharge from the eye, discomfort or pain, redness, blurry vision and increase sensitivity to light.
Clara Oliva, from Florida, is suing the makers of EzriCare Artificial Tears after she was left legally blind after using the products.
Her lawyer Natasha Cortes said: "My client is horribly injured and now legally blind. I am currently investigating others similarly injured by this recalled product.
"These companies must be held accountable for the devastating consequences their product has caused Ms. Oliva and other consumers.”
According to Statista, a market research firm, eyedrops and eyewash products are used by nearly 17 million Americans.
