What Are the Warning Signs of Infection After an Eye Injury?

After an eye injury has been treated or is healing, people watch anxiously for signs that it is going bad, unsure how to tell normal soreness and redness, which should be improving, from an infection setting in. They want a clear list of what to look for so they know when to go back rather than wait and hope.

Any injury that breaks the surface of the eye or the skin around it creates an opening for bacteria or, less often, fungi. A scratch on the cornea can become an infected corneal ulcer; a cut in the lid can become infected; and most seriously, a wound that penetrated into the eye can seed an infection inside it.

Infection matters so much in the eye because the internal structures, the cornea and the retina, do not tolerate infection or the inflammation it causes. A corneal infection can scar the clear window and blur vision; an infection inside the eye can damage the retina within days. The eye's normal course after an injury is to improve, so the pattern that signals trouble is the opposite: pain, redness, swelling, or discharge increasing rather than fading, or vision worsening rather than clearing. Recognizing that reversal early is what allows treatment before permanent damage is done.

After a corneal abrasion or a foreign-body removal, a small area of the cornea's surface is open, and bacteria can invade to form a corneal ulcer (microbial keratitis), which shows up as increasing pain, redness, light sensitivity, discharge, and sometimes a visible white spot on the cornea. Contact lens wearers and injuries involving soil, plant matter, or dirty objects are at higher risk. This needs urgent culture and intensive antibiotic drops.

Endophthalmitis is infection within the eye itself, the feared complication of a penetrating or open-globe injury, particularly with organic material or a retained foreign body. It causes rapidly worsening pain and vision, marked redness, swelling, and often pus visible in the front of the eye, and can blind an eye within days if untreated. Around the eye, an infection of the socket tissues (orbital cellulitis) produces a swollen, red, painful eye that bulges, moves poorly, and comes with fever. Each of these is why any worsening after an injury is taken seriously and re-examined promptly.

Seek same-day care, or an emergency room for severe cases, if after an eye injury you develop:

• Increasing pain, redness, or eyelid swelling instead of gradual improvement.
• Thick, colored, or pus-like discharge, or your eyelids stuck together.
• Worsening blurred vision or increasing light sensitivity.
• A visible white spot on the cornea, or pus visible in the front of the eye.
• Fever, a bulging eye, an eye that cannot move fully, or redness spreading onto the cheek or forehead.
• Any of these after a wound that may have penetrated the eye, treat it as an emergency.

The doctor measures vision and examines the eye at the slit-lamp, often with fluorescein dye, to look for a corneal ulcer, an infiltrate (a white spot of infection), discharge, and inflammatory cells or pus in the anterior chamber. If a corneal infection is present, the ulcer may be scraped and cultured to identify the organism and guide antibiotics. When infection inside the eye is suspected, the retina is examined and ultrasound may be used if the view is cloudy, and a sample of the fluid inside the eye can be taken for culture. If the socket is involved, eye movements, bulging, and vision are assessed and CT imaging of the orbit is ordered.

A corneal ulcer is treated with frequent, intensive antibiotic drops, adjusted once cultures return, and followed closely. An infection inside the eye (endophthalmitis) is an emergency treated with antibiotics injected directly into the eye and, in severe cases, surgery to remove the infected vitreous. Orbital cellulitis is treated with systemic (often intravenous) antibiotics and sometimes surgical drainage. Lid and surface infections are treated with appropriate antibiotics. Across all of these, the earlier treatment starts the better the outcome, which is why prompt re-evaluation at the first sign of worsening is the key step.

• Do not wait and hope if the eye is getting worse rather than better; worsening after an injury is the warning sign.
• Do not use leftover antibiotic or steroid drops on your own; a steroid can make an untreated infection much worse.
• Do not keep wearing contact lenses in an injured or red, painful eye, and do not patch a possibly infected eye.
• Do not rub or press on the eye, and do not try to clean out discharge aggressively.
• Do not dismiss fever, spreading redness, a bulging eye, or rapidly worsening vision as minor; these need urgent care.

If an eye that was healing after an injury starts getting worse, more pain, redness, swelling, discharge, or worsening vision, call May Eye Care Center to be re-examined the same day. Go to an emergency room for severe pain, rapid vision loss, a bulging eye with fever, or any sign of infection after a wound that may have penetrated the eye. Patients in the Hanover area can reach the office to arrange prompt evaluation and start treatment early.

After an eye injury, watch for the eye getting worse instead of better, more pain, redness, swelling, pus, or worsening vision, and get same-day care, because an infection, especially inside the eye, can threaten your sight and needs early treatment.