You recently had surgery on your eyes, like getting rid of cataracts or getting an injection for a condition like macular degeneration. You know that you might feel some pain as you heal, but instead, your eye gets worse and worse, and your vision, which was supposed to be getting better, is getting worse. This isn't a normal part of getting better. This is a big sign that you might have endophthalmitis, a serious infection inside the eye. Endophthalmitis is a real eye emergency that can cost you your sight every hour that goes by. Your Direct Primary Care (DPC) doctor can be very helpful as your first point of contact for quick, life-saving triage, even though an eye specialist will be in charge of the treatment.
Endophthalmitis is a rare but very serious infection of the fluids (the vitreous and aqueous humor) and tissues inside the eye.
The Most Common Reasons:
Most of the time, it happens as a rare side effect of eye surgery, like cataract surgery.
It can also happen after an injection into the eye (a shot of medicine).
Bacteria can get into the eye if you get a penetrating eye injury.
It can be endogenous, which means that a severe infection from another part of the body (like a blood infection) spreads to the eye.
The "Red Flag" Signs of an Emergency:
You need to call your eye doctor or go to the emergency room right away if you have had eye surgery or an injection recently and you:
A big, steady loss or decrease in vision.
Pain in the eyes that is deep, constant, and getting worse.
The eye is getting redder.
A hypopyon is a layer of white pus that can be seen in the front of the eye.
Time is Vision: This is the basic idea behind treating endophthalmitis. Even a few hours of delay in treatment can make things much worse, such as losing your eyesight permanently or even losing your eye.
Notice: DPC doctors do not treat endophthalmitis that is still going on. An ophthalmologist (eye surgeon) needs to take care of this real emergency right away. They can do things like inject antibiotics directly into the eye (intravitreal injection) or do emergency surgery (vitrectomy). DPC's most important job is to quickly identify and sort patients. This is why a DPC doctor is such an important partner:
A "First Alert" System for a Patient After Surgery:
This is the most important thing a DPC doctor can do for this condition.
Access right away, 24/7: If you are a DPC member and your eye becomes painful, red, and your vision gets worse after a procedure, you can call or text your doctor right away, day or night.
Triage by an expert, urgent: Your DPC doctor will see these signs right away and know that they are a sign of endophthalmitis. They won't say, "Just wait and see." They will tell you to call your eye surgeon's on-call service right away or go straight to an emergency room that has an eye doctor on staff.
Getting around the delays in the healthcare system:
Your DPC doctor is on your side.
They can often call the emergency room or the on-call ophthalmologist directly for you.
They can make sure your case gets the attention it needs as soon as you arrive by sending a clear, concise report from one doctor to another ("My patient is 4 days post-op from cataract surgery and now has a red, painful eye with decreased vision and a hypopyon...").
A Partner in Coordinated Post-Acute Care:
Your DPC doctor will be your main doctor for recovery after the ophthalmologist has treated and stabilized your eye.
They can help with any systemic (oral or IV) antibiotics that need to be given.
They will take care of your overall health, such as your blood sugar if you have diabetes, to make sure that your eye has the best chance of healing.
Case 1: Maria, 75, had cataract surgery five days ago. When she wakes up, her eye is red, hurts a lot, and she can't see as well as she could the day before. At 7 AM, she calls her DPC doctor's cell phone. The doctor sees the signs of endophthalmitis right away and tells her to call her surgeon's office emergency line right away to report these specific symptoms. The surgeon's office tells her to come in right away, and that morning she gets an intravitreal injection that saves her vision.
Case 2: David, 68, is being treated by his DPC doctor for a serious staph infection in his blood (bacteremia). David says that his right eye hurts and his vision is a little blurry during a daily telehealth check-in. His DPC doctor knows that endogenous endophthalmitis is a risk, so he quickly sets up an urgent consultation with a local ophthalmologist for the same day. The ophthalmologist can catch and treat the eye infection at its very first stage.
Q: I just had surgery on my eyes. Isn't it normal for it to hurt and be blurry while it heals?
A: It's normal to feel a little uncomfortable and have some blurriness at first, but your eye should feel better every day, not worse. If you have severe pain that gets worse and your vision gets worse after the first day or two, that's a big red flag that needs to be checked out right away.
Q: Should I call my DPC doctor or my eye surgeon first?
A: If you just had eye surgery, the office of your eye surgeon should be the first place you call for any urgent eye problem. They have a 24/7 on-call system for this kind of emergency. But a lot of patients have a strong and trusting relationship with their DPC doctor and feel better calling them first. A good DPC doctor will quickly see that you need help and send you to the right place, often making it easier for you to get in touch with your surgeon right away.
Q: What does it mean to have a "intravitreal injection"?
A: This is the main treatment for endophthalmitis that saves vision. An eye doctor uses a very fine needle to put a strong dose of antibiotics right into the vitreous, which is the gel-like stuff that fills the inside of your eyeball. This is the quickest and most effective way to get a lot of medicine right to the infection site.
DPC has a clear advantage in this vision-threatening emergency because:
Setting up a quick, professional "First Alert" system: DPC's 24/7 access is very important for quickly sorting out a medical emergency where every hour counts.
Making it easier to make urgent, coordinated referrals: A DPC doctor can often get around system problems and talk directly to a specialist to make sure a patient gets the care they need right away.
Providing Full Post-Acute Care: Acting as the medical home to help a patient recover and keep track of their overall health after a terrible eye infection.
Some signs of problems with your vision need immediate and expert attention. Endophthalmitis is a real eye emergency. You need a medical partner who knows when to act quickly and where to send you right away. Direct Primary Care is that watchful, responsive, and well-coordinated first line of defense that can help protect your valuable vision.
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