Post-operative problems (Guidelines)

Warning

Audience

  • Highland Health and Social Care Partnership
  • Primary and Secondary Care

Introduction

Have a low threshold for contacting the on-call Ophthalmologist for all patients presenting from 08.00-20.00 who are within 2 weeks of an operation or injection

Endophthalmitis

  • not common
  • 1 to 14 days after operation or injection
  • moderate to severe eye pain not helped by proxymetacaine drops
  • marked visual loss (usually 6/24 or worse)
  • Hypopyon
  • Emergency: see separate “Endophthalmitis” section for management

Ocular surface disturbance/corneal abrasion

  • common
  • within hours of operation
  • discomfort and decreased visual acuity (variable)
  • no hypopyon
  • some generalised corneal fluorescein uptake or frank corneal abrasion
  • discomfort immediately settles with topical local anaesthetic, eg, proxymetacaine
  • Management: Chloramphenicol ointment and reassurance

Post-op iritis

  • common
  • within days or weeks of operation
  • discomfort and mildly decreased visual acuity
  • if only mild conjunctival redness, and no hypopyonthen have excluded endophthalmitis
  • Management: review the following day in the Ophthalmology unit

Raised intraocular pressure

  • not common
  • if only mild conjunctival redness, and no hypopyon, then check intraocular pressure (IOP) with tonometer (A&E Raigmore)
  • if raised (over 30) or can’t check pressure, consider start topical glaucoma medication as per Acute Angle Closure Glaucoma protocol (Latanoprost, Timoptol and Iopidine) and arrange review following day in Ophthalmology Unit

Last reviewed: 28/03/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1.1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist .

Document Id: TAM550

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