Eye drop shortage in France: what is missing, why, and what it changes for you

On 23 July 2026, France’s medicines agency (ANSM) published the list of eye drops facing supply pressures and asked healthcare professionals to conserve the stocks still available. Eleven products are affected, two of them under very severe pressure. Most are not treatments you take at home: they are the drops your ophthalmologist uses during the examination. Here is exactly what is missing, why, and what it may realistically change at your next appointment.

THE ANNOUNCEMENT

What the ANSM announced on 23 July 2026

The agency published a news item titled, in the French original, “Tensions en collyres : bien les prescrire pour préserver les stocks disponibles” (“Supply pressures on eye drops: prescribing them carefully to preserve available stocks”). The message has two parts: first the named list of affected products, and second an explicit request to prescribers and pharmacists to ration the use of these products until the situation returns to normal.

The ANSM points out that these pressures are nothing new: they have been “affecting various eye drops for several months for a variety of reasons” and are “now compounded by the difficulties encountered at the French production site of Excelvision” (translated from the French). In other words, the industrial incident did not create the shortage; it tipped over a situation that was already fragile.

The two eye drops under very severe pressure

• Fluorescéine Faure 0.5%, eye drops in single-dose vials (fluorescein).
• Mydriaticum 2 mg/0.4 mL, eye drops in single-dose vials (tropicamide).

The nine other products under supply pressure

• Néosynéphrine 2.5% Faure and Néosynéphrine 10% Faure, single-dose vials (phenylephrine).
• Voltarenophta 0.1% (0.3 mg/0.3 mL) single-dose vials and Voltarenophtabak 1 mg/mL (diclofenac).
• Verkazia 1 mg/mL, eye drops in emulsion form (ciclosporin).
• Oxybuprocaine hydrochloride Théa 1.6 mg/0.4 mL, single-dose vials.
• Tetracaine 1% Théa, single-dose vials.
• Dexocol 1 mg/mL (dexamethasone).
• Chibroxine 0.3% (norfloxacin).

The agency says it is working with the laboratories concerned to bring supply back to normal, “notably through imports arranged at our request”. No date has been given for a return to normal.

THE CAUSE

Why it is mainly single-dose vials that are missing

One detail leaps out when you read the list: of the eleven products, eight are single-dose vials. The ANSM says as much itself: “these pressures mainly concern single-dose eye drops”. That is no coincidence, and it deserves an explanation, because the format of an eye drop is not simply a packaging choice.

A conventional multidose bottle contains a preservative, most often a quaternary ammonium compound, whose job is to prevent bacterial contamination of the liquid between two instillations. That preservative comes at a biological cost: used repeatedly and over long periods, it damages the epithelium of the ocular surface. This is a very concrete issue in clinic, particularly in patients on long-term treatment or who already have dry eye. The industry’s answer was the single-dose vial: a sealed, single-use pipette that needs no preservative because it is discarded after use.

That elegance comes at an industrial price. Filling and sealing millions of micro-pipettes under sterile conditions requires specialised production lines, few in number and hard to switch from one site to another. When one of them stops, there is no immediate back-up capacity, unlike a bottle, whose manufacture is far more ordinary. That is what makes the single-dose supply chain particularly vulnerable, and why a single site in difficulty can empty an entire shelf.

The ANSM adds that these difficulties are arising “against an already fragile international backdrop for certain ophthalmic medicines”. This announcement should therefore be read as the local symptom of a wider phenomenon, not as an isolated accident.

IN THE CONSULTING ROOM

What these eye drops are actually for

This is the point that media coverage of a shortage almost always misses: the public pictures treatments being taken away from patients, when in fact most of the products on this list are examination tools. They do not leave the pharmacy in a bag; they are instilled by the doctor or the orthoptist during the consultation, and discarded within the minute. Let us go through them.

Fluorescein: making visible what is not

Fluorescein is a fluorescent orange dye with a remarkable property: it does not penetrate an intact corneal epithelium. It only takes up where the surface layer is missing or damaged. Under the blue light of the slit lamp, an erosion, an ulcer or a scratch invisible to the naked eye then stands out in bright green, with sharp, measurable outlines.

This drop is therefore central to diagnosing keratitis, to assessing an injury to the cornea, to searching for a foreign body, and to the Seidel test that checks whether a wound is watertight. It is also indispensable for measuring intraocular pressure by applanation tonometry, the reference method for glaucoma screening, and for fitting rigid contact lenses, where the spread of the tear film beneath the lens is observed. Without fluorescein, part of the clinical picture of the ocular surface becomes invisible again.

Tropicamide: opening a window onto the retina

Mydriaticum contains tropicamide, a short-acting dilating agent. Instilled once or twice, it dilates the pupil in about twenty minutes, and the effect wears off within a few hours. This dilation is anything but incidental: through an undilated pupil, only a fraction of the back of the eye can be seen. It has to be widened in order to examine the peripheral retina and to confirm, for example, that there is no tear.

That is what makes this product strategic. The dilated fundus examination is what annual screening for diabetic retinopathy rests on, along with the assessment of a retinal detachment in someone reporting a shower of floaters, the monitoring of AMD, and the pre-operative assessment before surgery. Pressure on tropicamide supply therefore does not affect a niche: it affects the routine eye examination.

Phenylephrine: more dilation, by another route

Néosynéphrine contains phenylephrine, which achieves dilation through a different mechanism from tropicamide: it contracts the dilator muscle of the iris instead of relaxing the sphincter. The two are often combined when wide dilation is needed, typically before surgery or in patients whose iris dilates poorly, such as heavily pigmented eyes or people with long-standing diabetes.

Topical anaesthetics

Oxybuprocaine and tetracaine numb the surface of the eye within seconds, for around ten minutes or so. They make bearable procedures that would otherwise be impossible: measuring intraocular pressure by contact, removing a foreign body, placing an examination lens on the cornea, or carrying out retinal laser treatment.

A firm word of caution is needed here, because it saves corneas. These anaesthetics must never be used as self-medication. Repeated use of a topical anaesthetic blocks healing of the epithelium and causes a keratopathy that can end in a deep ulcer, sometimes a permanent one. The immediate relief is real; so is the spiral that follows. Eye pain that persists calls for a diagnosis, not for a drop that wipes it away.

The treatments, by contrast, do leave the pharmacy

Four products on the list are exceptions and directly concern patients at home. Diclofenac (Voltarenophta, Voltarenophtabak) is a non-steroidal anti-inflammatory widely prescribed after cataract surgery, alongside corticosteroids, as part of post-operative care. Ciclosporin (Verkazia) is indicated in severe vernal keratoconjunctivitis in children, a form of eye allergy that is anything but trivial and whose treatment runs over months. Dexamethasone (Dexocol) is a corticosteroid, and norfloxacin (Chibroxine) an antibiotic.

These four are the ones that can genuinely lead a patient to leave a pharmacy without their treatment. They are also the ones for which the right reflex matters most, and I come back to that below.

IN PRACTICE

What this changes for your appointment

Let us be clear about the scale of this: supply pressure is not a complete stock-out. Practices and clinics hold stock, the imports requested by the ANSM are starting to arrive, and alternatives exist for several molecules. You will very probably notice no difference at your consultation.

What the situation does impose is discipline in use. In my own practice, that translates into simple judgement calls: not dilating as a matter of routine when the examination does not call for it, not instilling fluorescein “just to have a look” when the history and the slit lamp are enough, not reaching automatically for an anaesthetic when a non-contact pressure measurement will do. These choices do not degrade the quality of the examination; they remove consumption that was adding nothing.

One point is worth planning for if you have to drive. When dilation is needed, it blurs near vision and causes glare for a few hours. Arrange not to drive off straight away, and bring sunglasses. This has nothing to do with the shortage, but it is the question that comes up most often once tropicamide enters the conversation.

THE INSTRUCTIONS

The ANSM’s four requests to healthcare professionals

The agency sets out four instructions, which I reproduce as they stand, translated from the French, because their wording is precise:

1. “Use eye drops only in situations where their use is essential and cannot be postponed”.
2. “Give preference to the available alternatives wherever this is possible”.
3. “Limit prescriptions and dispensing to strictly necessary quantities”.
4. “Avoid building up precautionary stocks”.

The fourth is the most interesting, because it describes a mechanism seen in every medicines shortage. Once the news circulates, everyone tries to secure their own reserve: patients ask for a spare box, pharmacies order beyond their needs, hospitals build a buffer. These behaviours are individually rational and collectively destructive: they turn a manageable strain into a genuine stock-out by concentrating demand into a few weeks. That is exactly why the ANSM takes the trouble to write it down.

WHAT TO DO

If your eye drops are unavailable at the pharmacy

This mainly concerns patients on diclofenac, ciclosporin, dexamethasone or norfloxacin. Here is what to do, in order.

• Do not stop the treatment on your own initiative. Interrupting an anti-inflammatory after cataract surgery, or maintenance treatment for a severe allergy, is not a neutral act. The risk of stopping is very often greater than the inconvenience of waiting a few days.
• Let the pharmacist do the searching. They are the ones who know what is left across the network, which different presentation exists, and which import has arrived. The ANSM states explicitly that “for certain medicines, alternatives or different presentations may cover part of patients’ needs”.
• Call the prescriber if nothing can be found. A therapeutic equivalent exists in most cases, but choosing it is a medical decision: the substitute molecule, its concentration and how often it is instilled all depend on the indication and on the state of your eye.
• Do not buy eye drops online outside the pharmacy network. An eye drop is a sterile product placed on a tissue that has no immune defences of its own. Traceability of the cold chain, of sterility and of composition is not an administrative formality.
• Do not reuse an opened single-dose vial and do not share a bottle with someone close to you. A single-dose vial contains no preservative: beyond a few hours, it becomes a culture medium.

And if you have unused, expired or no-longer-needed boxes at home, take them back to the pharmacy rather than leaving them to gather dust in a cupboard. At a time of supply strain, an unused treatment is not merely waste: it is a dose that somebody else is going without.

FAQ

Frequently asked questions

Sources

1. ANSM. Tensions en collyres : bien les prescrire pour préserver les stocks disponibles. Published 23 July 2026. ansm.sante.fr
2. Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-334. PMID: 20302969
3. Yagci A, Bozkurt B, Egrilmez S, Palamar M, Ozturk BT, Pekel H. Topical anesthetic abuse keratopathy: a commonly overlooked health care problem. Cornea. 2011;30(5):571-575. PMID: 21598429

Further reading

• Dry eye: causes, symptoms and treatments
• Keratitis: recognising and treating inflammation of the cornea
• Dr Moïse Tourabaly — Ophthalmologist

Cachan practice · Tel. +33 1 45 47 08 11

Disclaimer

This article is intended for information only. A personalised ophthalmological opinion remains essential for any treatment decision.

This article describes a supply situation as it stood on 23 July 2026 and constitutes neither a prescription nor advice on substitution. It is not a substitute for a medical consultation. Never interrupt an ongoing eye treatment without the prescriber’s advice, and never use anaesthetic eye drops as self-medication. The most up-to-date information on the availability of each product can be found in the shortage records published by the ANSM.