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After cataract surgery: the complications the general doctor sees

  • Topic

Most eyes see well after cataract surgery. Pain, worsening vision or increasing redness in the first days is endophthalmitis until proven otherwise.

Updated

See it in 3D: Lens · Macula · Retina · Cornea

What it is

In phacoemulsification the cloudy lens is broken up through a small incision and an artificial lens is placed in the capsular bag. The normal course is mild grittiness and redness, vision improving within days, and steroid, antibiotic and anti-inflammatory drops for some weeks. Complications follow a timeline: toxic anterior segment syndrome in the first day, endophthalmitis in the first week, raised pressure and corneal oedema early, cystoid macular oedema after weeks, and retinal detachment and posterior capsule opacification months to years later.

Key facts

  • Acute endophthalmitis: usually within the first week; pain, falling vision, red eye, lid swelling and hypopyon; most often skin bacteria such as coagulase-negative staphylococci.
  • Toxic anterior segment syndrome: sterile inflammation within a day, with marked corneal oedema and little pain; it must not be confused with infection.
  • Cystoid macular oedema (Irvine-Gass): blur some weeks after surgery; more common with diabetes, uveitis and a ruptured posterior capsule.
  • Posterior capsule opacification: the most common late cause of gradual blur and glare; treated with a quick YAG laser capsulotomy.
  • Retinal detachment: flashes, floaters and a curtain, months or years later; higher risk in high myopia, young men and after capsule rupture.
  • Floppy iris during surgery is linked to tamsulosin and other alpha-blockers, even if stopped long before.

In clinical practice

  • Patients often say their cataract has come back: it is almost always posterior capsule opacification, which laser clears.
  • Hypopyon after eye surgery is never treated as conjunctivitis or uveitis without an ophthalmologist.
  • Steroid drops can raise eye pressure after surgery; headache, nausea or halos in the first days need a pressure check.
  • Persistent corneal oedema after surgery (bullous keratopathy) may need an endothelial corneal graft.

Next step / Initial management

  • Pain, worsening vision, increasing redness or hypopyon after intraocular surgery: same-day ophthalmology (vitreous sampling and intravitreal antibiotics); do not start drops and wait.
  • New flashes, floaters or a curtain at any time after surgery: same-day ophthalmology (retinal detachment).
  • Gradual blur or glare months or years after surgery: routine referral for YAG capsulotomy.
  • Blurred vision some weeks after surgery, especially with diabetes: refer soon for OCT (cystoid macular oedema).
  • On the referral for cataract surgery, list alpha-blockers, anticoagulants and any earlier refractive surgery.

Test yourself

Think of the answer, then tap the question to see it.

Four days after cataract surgery a patient has pain, worse vision and a hypopyon. What is it and what is the next step?

Acute postoperative endophthalmitis; same-day ophthalmology for vitreous sampling and intravitreal antibiotics.

Two years after cataract surgery, vision blurs gradually with glare. What is the likely cause and treatment?

Posterior capsule opacification, treated with YAG laser capsulotomy.

Which drug taken for prostate symptoms should be reported before cataract surgery, and why?

Tamsulosin, because it causes intraoperative floppy iris syndrome.

Six weeks after surgery in a diabetic patient, vision blurs. Which complication is suspected and how is it confirmed?

Cystoid macular oedema, confirmed with OCT.

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The structures of Durgical's 3D anatomy where it is found.

In Pharmacology6

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Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: Cataract Surgery (StatPearls Publishing (NCBI Bookshelf), 2023); Bacterial Endophthalmitis (StatPearls Publishing (NCBI Bookshelf), 2026); Macular Edema (StatPearls Publishing (NCBI Bookshelf), 2024); Pseudophakic Bullous Keratopathy (StatPearls Publishing (NCBI Bookshelf), 2023); Posterior Capsule Opacification (EyeWiki (American Academy of Ophthalmology), 2025).

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Representative model, for educational purposes only.