I found what was causing the issue with this extension only working intermittently. It was another extension called "Don't Accept image/webp", which is designed to stop sites serving up WebP images. With both extensions enabled at the same time, sometimes the Reddit images extension would stop working, but would work again if you disabled and re-enabled it. If the WebP extension was disabled, the Reddit one worked perfectly.

I have added an exception for Reddit in the WebP extension and now there are no conflicts and both extensions function fine.

I've raised my score to 5 stars, but I'll leave the original review below: -

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If you close your browser and re-open it, the extension no longer works until you disable, then re-enable it.

The functionality is great, but if you could fix that issue, it would be perfect.