Post-injection endophthalmitis is rare and time-critical, and the interval that decides the outcome is the one between the patient noticing something and the patient being seen. That interval is set almost entirely by what they were told on the way out.
So make the discharge instruction three symptoms and a number. Pain that is new or worsening, vision that is getting worse rather than better, and redness that is increasing - any one of them, on any day in the week after an injection, means being seen the same day. Give them a telephone number that is answered out of hours and say explicitly that they should use it rather than wait for the next clinic.
The common failure modes are worth naming to the patient. Mild grittiness and a subconjunctival haemorrhage are expected and are not this. Discomfort that settles over hours is not this. Getting steadily worse from day two onwards is. Write it down, because the person who has just had a needle in their eye is not committing your instructions to memory - and in a busy list, the thirty seconds this takes is the cheapest intervention available.
- Give three symptoms in writing: new or worsening pain, worsening vision, increasing redness.
- Say 'same day', not 'contact us' - the delay is usually in the patient waiting to be sure.
- Provide a number that is answered out of hours and confirm they have it before they leave.
- Name what is normal - grittiness, subconjunctival haemorrhage, discomfort that settles - so the warning signs stand out.
- Record in the notes that the warning was given; it is also what protects the patient at the next contact.
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