Follow doctor's orders to avoid infection after eye surgery

DEAR DOCTOR K: A few weeks after my cataract surgery, my eye began to hurt and my eyelid became swollen. My doctor said I have "endophthalmitis." What is this? Is it related to my cataract surgery?

DEAR READER: Endophthalmitis is inflammation inside the eye that is usually triggered by an infection. In the United States, most cases are caused by bacterial infections that develop after eye surgery. Endophthalmitis is a serious problem that can lead to permanent loss of vision.

The inflammation affects the vitreous fluid, the clear gel that supports and fills the rear two-thirds of the eyeball. The inflammation can also extend to nearby tissues in the eye. (I've put an illustration showing the inner workings of the eye on my website, AskDoctorK.com.)

Symptoms can vary slightly, depending on how soon after surgery the infection develops. Early symptoms can include:

- A dramatic decrease in vision in the affected eye;

- Eye pain that gets progressively worse without treatment;

- Red eyes;

- Swollen eyelids.

Late symptoms tend to be milder than early symptoms. They may include blurred vision and increased sensitivity to bright light.

To maximize your chances of preserving and restoring your vision, treatment should begin right away. You are likely to be treated with one or more of the following:

- Antibiotics injected directly into the infected eye.

- Cort-icosteroids injected into your eye to decrease inflammation and speed healing.

- Antibiotics injected into a vein.

- Antibiotics applied to the surface of the eye.

- A procedure in which part of the infected vitreous fluid is removed and replaced with sterile saline or another liquid.

Once treatment begins, symptoms may begin to improve within a day or two. Eye pain and eyelid swelling usually decrease before vision improves.

The best way to reduce your risk of infection after eye surgery is to follow your doctor's post-surgery care instructions. For example, faithfully using antibiotic and cortisone drops or ointment will help prevent infection and reduce inflammation. Wash your hands thoroughly before applying the drops, and avoid touching the bottle tip to your eye.

You should also avoid rubbing or touching your eye after eye surgery. You may need to wear a protective eye shield at night for a few days or weeks. This will help you to avoid accidentally rubbing your eye while you sleep.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.