Endophthalmitis — Urgent Eye Infection Care in Jacksonville, Florida
Endophthalmitis is infection inside the eye. It is rare, it moves fast, and the outcome depends heavily on how quickly it is treated. If you have had an eye injection or eye surgery and develop pain, worsening vision, or increasing redness, that is not something to sleep on.
What to do — read this first
During office hours: call us at (904) 666-5050. Tell our staff you have had an injection or surgery and you have pain or worsening vision. That gets you seen the same day.
Outside office hours: call the same number and leave a voicemail. A member of our clinical team will get back to you.
If more than three hours have passed since you called and you have not heard back, go to an emergency room. Do not keep waiting. Tell them you have had an intraocular injection or eye surgery and you are concerned about endophthalmitis — that phrase will be understood.
Symptoms
- Pain — increasing rather than settling
- Vision getting worse after an injection or operation, rather than better
- Increasing redness
- Sensitivity to light
- New or heavy floaters, or a general haze over the vision
- A white or yellow layer visible at the bottom of the coloured part of the eye
Some grittiness, a red patch on the white of the eye, and mild irritation for a day or two after an injection are normal. The distinction that matters is direction: normal discomfort improves, infection worsens.
How likely is it, really
Low. After an intravitreal injection, endophthalmitis occurs in roughly 1 in 2,000 to 1 in 10,000 injections — most published series cluster around 0.03 to 0.05 percent, and some recent large series report rates as low as 1 in 11,000. After standalone cataract surgery, the rate is about 0.04 percent, which is a comparable per-procedure risk.
The reason we take it seriously despite the low rate is that a patient on regular injections has many exposures, and that the consequences of a delayed diagnosis are severe and permanent.
Timing
Post-injection endophthalmitis presents earlier than post-surgical endophthalmitis. In a large multicentre series the median was three days after the injection, with a range from one to 21 days. Most cases show up in the first three to five days.
So: any pain or worsening vision in the first week after an injection is a call. Do not wait for your next scheduled appointment.
How it is treated
Dr. Elkeeb treats endophthalmitis acutely and performs both approaches.
Tap and inject
A sample of fluid is taken from inside the eye for culture, and antibiotics are injected directly into the vitreous cavity. This is done in the office or the operating room, immediately, without waiting for culture results — treatment starts on suspicion, and the culture refines it afterwards.
Vitrectomy
Surgical removal of the infected vitreous, together with intravitreal antibiotics. Used for severe presentations and for eyes that do not respond to tap and inject. In some cases both are used in sequence.
What the evidence says, and what it does not
The Endophthalmitis Vitrectomy Study, published in 1995, remains the foundational trial. It established that in eyes with light-perception-only vision, immediate vitrectomy gave better results than tap and inject — 33 percent achieved 20/40 against 11 percent — and that eyes seeing hand motions or better did as well with tap and inject. It also established that intravenous antibiotics add nothing.
What it does not settle is post-injection infection. The trial enrolled only patients with infection after cataract surgery, in an era before intravitreal injections existed. The organisms differ — streptococcal infection occurs in roughly 30 percent of injection-related cases against about 9 percent after cataract surgery, and streptococcal infection does considerably worse. And injection patients have underlying macular disease that limits how much vision can be recovered even when the infection is controlled.
Applying the EVS rules mechanically to a post-injection infection is a misuse of the trial. The decision is made on the individual eye.
What the outcome looks like
Most eyes retain useful vision, but typically less than they started with. In a large multicentre series, median vision went from 20/40 before the injection to 20/60 a year afterwards. Culture-positive infections did worse than culture-negative ones — 20/80 against 20/40 — and streptococcal infections worst of all.
That is the overall picture: not usually blinding, not usually fully recoverable, and heavily dependent on how fast treatment started.
How we reduce the risk
- Povidone-iodine antisepsis to the ocular surface before every injection — the single most effective measure, and the one with the best evidence behind it
- A sterile lid speculum to keep lashes and lid margin away from the injection site
- No talking over the field — oral flora, particularly streptococci, are a recognised source
- Single-use prepared syringes and strict aseptic technique
Routine antibiotic drops after injection are not used. They have not been shown to reduce endophthalmitis and there is evidence they promote resistant organisms. If you were given antibiotic drops after injections in the past and we do not prescribe them, that is why.
Other routes of infection
Endophthalmitis can also follow penetrating eye trauma, and it can arrive through the bloodstream from an infection elsewhere in the body — endogenous endophthalmitis — most often in patients who are immunosuppressed, have indwelling lines, inject drugs, or have a liver abscess or endocarditis. That form needs the source found and treated as well as the eye, and it is a situation where dual training in internal medicine and ophthalmology is genuinely useful.
Questions patients ask
My eye is a little red and gritty after my injection. Is that normal?
Mild grittiness, a red patch on the white of the eye, and slight irritation for a day or two are common and normal. What is not normal is pain that increases, vision that worsens, or redness that spreads. Direction matters more than presence.
Should I go to the emergency room?
Call our office first — we can see you the same day during business hours, and an emergency room usually cannot provide the treatment. Outside hours, leave a voicemail. If more than three hours pass without a response, go to an emergency room.
Will I lose vision?
Most eyes keep useful vision, but often less than before. Speed of treatment is the factor most within anyone's control, which is the whole reason this page exists.
Should I stop having injections?
For nearly everyone, the risk from stopping treatment is far greater than the risk of infection. The disease being treated causes vision loss reliably; endophthalmitis is rare. We are glad to go through the numbers for your particular situation.
Getting seen
We accept urgent referrals and see urgent cases within 24 hours. Call (904) 666-5050. Our office is open 8:00 am to 5:00 pm, Monday to Friday, at 3627 University Blvd S, Suite 605, Jacksonville, FL 32216. Our staff speak English, Arabic, and French.
Dr. Elkeeb operates at HCA Florida Memorial Hospital and Baptist Medical Center Jacksonville.
Referring physicians and optometrists: our referral information is here.
Sources: EyeWiki, Endophthalmitis and Post-Injection Endophthalmitis (American Academy of Ophthalmology); Endophthalmitis Vitrectomy Study Group, Archives of Ophthalmology 1995; Xu D et al., multicentre 10-year review of post-injection endophthalmitis, Ophthalmology Retina 2023;7(6); IRIS Registry analysis of endophthalmitis after cataract surgery, Ophthalmology 2020.
This page is general information about a medical condition and is not a substitute for examination and advice from your own physician. Do not start, stop, or change any medication based on what you read here.