Situation: A 72-year-old man with type 2 diabetes mellitus and hypertension is scheduled for phacoemulsification with intraocular lens implantation in the right eye under topical anesthesia. Over the past 2 years he has noticed gradually blurred vision and glare when driving at night. On the third day after surgery he calls the clinic. Which report from him would require evaluation the same day?

Increasing pain with decreasing vision in the days after cataract surgery suggests endophthalmitis, an infection that can destroy the eye within days, so he must be seen at once. Mild scratchiness relieved by a simple analgesic, glare in bright light and brief blurring on waking are expected during early recovery.

Why option 3 is the priority

On the third postoperative day, a report of throbbing pain combined with vision that is worse than the previous day is a red flag for acute postoperative bacterial endophthalmitis. This is a fulminant intraocular infection involving the aqueous humor, vitreous body, and adjacent tissues, and it can produce irreversible vision loss within hours to days if treatment is delayed ^[1]. Any worsening inflammation or visual decline in the early days after cataract surgery must be treated as an ophthalmic emergency until proven otherwise. ^[2]

Pain and reduced visual acuity are the two most typical presenting symptoms of postoperative endophthalmitis ^[4]. The pain is usually deep, throbbing, and progressive rather than a mild surface irritation. The visual loss reflects inflammatory cells and purulent material accumulating in the vitreous and anterior chamber, which disrupts the normally clear optical pathway. Key point! The combination of increasing pain plus decreasing vision is far more concerning than either symptom alone because it signals active intraocular infection rather than normal postoperative inflammation.

Why the other options are expected findings

Report	Interpretation	Action
Glare in bright sunlight	Expected during early recovery; the new intraocular lens and corneal edema scatter light	Reassure; advise sunglasses
Mild scratchy feeling relieved by acetaminophen	Common surface irritation from the surgical wound or dry eye; responds to a simple analgesic	Routine follow-up
Slight blurring when first removing the shield	Transient blur from tear film changes, ointment, or corneal edema on waking	Routine follow-up

These three symptoms are consistent with normal healing. Mild scratchiness that is relieved by a simple analgesic, glare in bright light, and brief blurring on waking are all expected in the early postoperative period. They do not suggest progressive intraocular infection.

Clinical reasoning for same-day evaluation

Postoperative bacterial endophthalmitis most often presents acutely a few days after surgery, which matches the timing of this patient’s call on day three ^[2]. Suspicion of endophthalmitis requires emergent therapeutic management because early intervention improves both anatomical and functional outcomes. ^[2] The diagnosis is primarily clinical, supported by examination findings such as hypopyon and vitritis with loss of the red reflex, but the nurse’s role is to recognize the warning symptoms and arrange same-day ophthalmologic evaluation ^[4].

Nearly all patients with endophthalmitis present with decreased vision, and many also report eye pain . The patient’s description of vision worse than yesterday is therefore a critical data point. Watch out! Do not dismiss worsening vision as “normal blurring” after cataract surgery. A patient who reports that vision is clearly worse than the previous day, especially with throbbing pain, needs immediate clinical assessment rather than telephone reassurance.

Differential considerations

Other causes of postoperative inflammation can mimic endophthalmitis, including toxic anterior segment syndrome, phacoantigenic uveitis, and inflammation from implant malposition ^[2]. Each requires its own specific treatment, so the same-day evaluation serves both to rule in endophthalmitis and to identify these alternative diagnoses. The key nursing action is not to distinguish among them over the phone but to recognize that acute worsening pain and vision after cataract surgery cannot wait for a routine appointment.

Pathophysiology link

In bacterial endophthalmitis, microbial proliferation within the closed ocular environment triggers an intense inflammatory cascade and breakdown of the blood–ocular barriers ^[1]. This leads to purulent exudate in the aqueous and vitreous, which directly degrades visual acuity. The throbbing quality of the pain reflects elevated intraocular pressure and ciliary body inflammation, distinguishing it from the superficial scratchiness of a healing corneal wound. The infection can destroy intraocular structures within days, so the window for preserving useful vision is narrow. ^[1]