Warning Signs That Need an Immediate Call to the Cataract Surgeon

Cataract surgery has a complication rate under 1 percent, but the complications that do occur tend to be time-sensitive. The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery publish nearly identical warning-sign lists, and every accredited surgical center hands the same printed sheet to the patient at discharge. Memorize the list, post it on the refrigerator, and program the after-hours surgeon phone number into a phone speed-dial. Same-day intervention can save sight, while a 48-hour delay can permanently reduce vision.

The first warning sign is sudden, severe pain. Routine post-op discomfort feels like mild grittiness, a foreign-body sensation, or a dull ache for 24 to 48 hours, and ibuprofen or acetaminophen handles it well. Sudden sharp pain after the first 48 hours, especially pain that wakes the patient from sleep or is paired with nausea and vomiting, is not normal. It can signal an acute pressure spike, called postoperative glaucoma, or the start of endophthalmitis, an intraocular infection. Both need same-day evaluation.

The second warning sign is a sudden drop in vision. Patients should expect blurry vision in the first day or two, then steady improvement. A sudden worsening, especially in week one or week two, points to either endophthalmitis or cystoid macular edema. Endophthalmitis usually arrives between post-op day three and day seven, with redness, pain, vision drop, and pus in the front of the eye visible in a mirror as a yellow-white layer at the bottom of the colored iris. This is a sight-threatening emergency requiring intravitreal antibiotic injection within hours.

The third warning sign is a new shower of floaters or a sudden burst of flashes. Floaters are small specks that drift across the field of view. After cataract surgery, a small number of floaters is common as the vitreous gel settles. A sudden burst of dozens or hundreds of new floaters, paired with light flashes that look like lightning in the corner of vision, points to a retinal tear or retinal detachment. The risk is highest in the first six months after surgery and remains slightly elevated for years. Sources: aao.org/eye-health/treatments/cataract-surgery-complications, ascrs.org/patients/post-op-care, and medicare.gov/coverage/cataract-surgery.