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Scleral Buckling Surgery for Retinal Detachment
Who Is a Candidate for Scleral Buckling
Not every retinal detachment is treated the same way. A retina specialist evaluates multiple factors to determine whether scleral buckling is the right approach for each patient.
Scleral buckling tends to work best for younger patients who still have their natural lens (called phakic patients) and have a relatively uncomplicated detachment. A single retinal tear or a small cluster of tears located in one area of the eye are favorable conditions for this approach.
When the vitreous gel is still firmly attached to the retina, scleral buckling avoids disturbing that relationship, which can be an important advantage over vitrectomy in these cases.
Certain factors raise a person's likelihood of developing a retinal detachment. Knowing these risk factors helps identify patients who benefit from closer monitoring and regular dilated eye exams.
- High myopia (severe nearsightedness, generally greater than 6 diopters)
- Previous cataract surgery, especially if complications occurred during the procedure
- Eye trauma or blunt injury
- Family history of retinal detachment
- Lattice degeneration, which refers to thin or weakened areas in the peripheral retina
Some conditions make a successful single-surgery repair more challenging. Proliferative vitreoretinopathy (PVR), a process in which scar tissue forms on the retinal surface following a detachment, is one of the most common reasons a retina can re-detach after surgery.
Multiple retinal breaks spread across different areas of the eye, or a detachment that has already reached the macula (the central zone of the retina responsible for sharp vision), can also influence surgical planning and expected recovery. A retina specialist evaluates all of these factors before recommending a surgical approach.
Recognizing the Warning Signs
Retinal detachment is a medical emergency that requires immediate evaluation. Recognizing the symptoms early and acting quickly gives the best chance of preserving vision.
These symptoms should never be ignored or waited on. If you experience any of the following, contact a retina specialist or go to an emergency room right away.
- A sudden increase in floaters, which are spots or cobweb-like shapes drifting through your vision
- Flashes of light, especially in peripheral (side) vision
- A dark curtain or shadow spreading across any part of your visual field
- Sudden vision loss in one eye
A retinal detachment often begins with a retinal tear. At this early stage, new floaters or brief light flashes may appear. These symptoms can seem minor, but they should be taken seriously because fluid may already be moving through the tear.
As the detachment spreads, a shadow or curtain effect may creep in from the side of your vision. If the detachment reaches the macula, central vision becomes affected. Treatment before the macula detaches is consistently associated with better visual recovery, which is why speed of evaluation matters.
Rhegmatogenous retinal detachment is relatively uncommon in the general population, but it occurs with greater frequency among people who have the risk factors described above. It can affect people of any age, though it is more common in middle-aged and older adults and in those with high myopia.
Regular dilated eye exams are valuable for detecting retinal tears before they progress to a full detachment, particularly in higher-risk individuals.
Diagnosing Retinal Detachment
Accurate diagnosis guides every aspect of surgical planning. A retina specialist uses a combination of clinical examination and advanced imaging to map the detachment in detail before recommending treatment.
Diagnosis begins with a comprehensive dilated eye exam. Drops widen the pupil to allow a clear view of the entire retina. Using a bright light source and a specialized lens (an indirect ophthalmoscope), the retina specialist can examine the retina from edge to edge.
The location, size, and number of retinal tears or breaks are all carefully documented. This information directly shapes the surgical plan.
When blood or cloudy vitreous gel blocks a clear view of the retina, a B-scan ultrasonography (ultrasound of the eye) is used. This painless test uses sound waves to create an image of the structures inside the eye, including the position of the retina.
Optical coherence tomography (OCT) may also be performed. OCT produces a detailed cross-sectional image of the retina and is particularly helpful for determining whether the macula remains attached, which is a key factor in predicting visual recovery. Our retina team also uses fluorescein angiography, ICG angiography, color fundus photography, and B-scan echography as part of a thorough retinal evaluation when clinically indicated.
Before scheduling scleral buckling, the retina specialist completes a full evaluation that maps every retinal break, assesses the extent of the detachment, checks for signs of PVR, and reviews the patient's overall eye health and medical history. This step ensures that the surgical approach is tailored to the specific details of each patient's detachment.
The Scleral Buckling Procedure
Scleral buckling is a carefully planned surgical procedure performed in a controlled setting. Knowing what to expect at each stage can help reduce anxiety and prepare you for a smoother recovery.
Scleral buckling is typically performed on an outpatient basis, meaning patients go home the same day. You will receive specific instructions about avoiding food and drink for several hours before surgery. Eye drops are used to dilate the pupil and numb the surface of the eye before the procedure begins.
The procedure is generally performed under local anesthesia with sedation, though general anesthesia may be used in some cases. An anesthetic injection placed around the eye prevents pain and limits eye movement during surgery.
The retina specialist begins by making a small incision in the conjunctiva (the clear membrane covering the white of the eye) to expose the sclera underneath. The eye muscles are gently moved aside to allow access around the entire eye.
All retinal breaks are located using indirect ophthalmoscopy. Cryotherapy is applied to each break, creating a controlled freeze that forms a lasting adhesion between the retina and the underlying tissue. The silicone buckle element is then positioned precisely and sutured to the sclera. In some cases, the specialist may also drain fluid from beneath the retina to help it settle against the buckle more quickly.
A newer technique called chandelier-assisted scleral buckling uses a small fiber-optic light placed inside the eye along with a wide-angle viewing system. This gives the retina specialist a brighter and more detailed view of the retina throughout the procedure compared to traditional indirect ophthalmoscopy alone, which can improve the precision of tear localization and buckle placement.
Scleral buckling typically takes between one and two hours to complete. You will not feel pain during the procedure due to anesthesia. Once the anesthesia wears off after surgery, some discomfort, tenderness, and swelling around the eye is expected. Your retina specialist will prescribe medications to manage pain and protect against infection during the healing period.
Recovery After Scleral Buckling
Recovery from scleral buckling takes time and requires consistent follow-up with your retina specialist. Understanding the typical recovery process helps set realistic expectations and ensures you know when to seek urgent attention.
It is normal to experience moderate discomfort, redness, and swelling in the first several days. The eyelid may appear puffy and the eye may look bruised. Prescription eye drops, typically including an antibiotic and an anti-inflammatory medication, are given to support healing and reduce the risk of infection.
Physical activity should be restricted during early recovery. Your retina specialist will provide specific guidance on positioning, lifting restrictions, and activity limitations based on the details of your surgery.
The initial healing phase generally lasts two to four weeks. During this time, vision is usually blurry as the eye recovers and the retina reattaches. Visual improvement typically continues gradually over the following months, with final vision sometimes not stabilizing until three to six months after surgery.
Most patients can return to light daily activities within one to two weeks. The silicone buckle remains on the eye permanently in most cases and is not visible or noticeable once healing is complete.
Scleral buckling has a well-established track record for retinal detachment repair. Primary anatomic success rates, meaning the retina stays attached after a single surgery, are consistently high. When the retina does re-detach, additional surgery can often reattach it successfully.
As with any surgical procedure, complications are possible. Understanding what to watch for during recovery allows you to seek help promptly if something changes.
- Increased myopia (nearsightedness) due to the buckle altering the shape of the eye
- Double vision from changes in eye muscle position, which typically resolves on its own over time
- Buckle extrusion, a rare condition in which the silicone element works through the surface of the eye
- Infection around the buckle element
- Recurrent retinal detachment, particularly if PVR (scar tissue formation) develops
Life After Scleral Buckling
Most patients adapt well to the scleral buckle and resume normal activities after a full recovery. Long-term awareness and follow-up care remain important for protecting vision over time.
The silicone buckle remains on the eye in the vast majority of cases and becomes a stable part of the eye's structure. It is positioned beneath the conjunctiva and cannot be seen by others. After the initial healing period, most patients are not aware of its presence.
Final visual outcomes depend on how long the retina was detached, whether the macula was involved at the time of surgery, and how well the retina heals. Patients whose macula was still attached before surgery generally recover sharper central vision than those whose macula had already separated.
In a small number of cases, the scleral buckle may need to be removed at some point after the original surgery. Reasons can include infection, extrusion of the buckle through the eye surface, or persistent double vision that does not resolve. Risk factors for needing removal include a history of diabetes, a prior penetrating eye injury, or having had a combined procedure at the time of the original surgery.
Buckle removal is a separate surgical procedure. Your retina specialist will thoroughly discuss the risks and benefits before proceeding if removal becomes necessary.
Regular follow-up with a retina specialist remains important even after a successful repair. The treated eye continues to carry a higher risk for future retinal problems, including new tears or re-detachment. The other eye also deserves close monitoring, as people who have experienced a retinal detachment in one eye have an elevated risk in the fellow eye as well.
Scheduled dilated eye exams allow a retina specialist to identify new retinal tears, areas of thinning, or early signs of re-detachment before they progress into a more serious problem.
When to Seek Urgent Care
Knowing when to act quickly is one of the most important things a patient can do to protect their vision, both before and after surgery.
If you develop any symptoms suggesting a retinal detachment, including sudden new floaters, flashes of light, or a shadow across your vision, do not wait to see if symptoms improve. Retinal detachment does not resolve on its own and worsens with time. Contact a retina specialist immediately or go to the nearest emergency room.
Most post-operative discomfort is expected and manageable. However, certain symptoms after scleral buckling surgery should prompt an immediate call to your retina specialist, as they may indicate a complication requiring urgent evaluation.
- Severe eye pain that is not relieved by prescribed medication
- A significant or sudden decrease in vision
- Increasing redness or discharge from the eye, which may signal infection
- New flashes of light or a sudden increase in floaters
- A shadow or curtain returning anywhere in your visual field
- Double vision that persists or worsens after the early recovery period
Frequently Asked Questions
These answers address common questions patients have when considering or recovering from scleral buckling surgery.
Yes, it is very likely. The buckle changes the shape of the eye, which typically increases myopia (nearsightedness) to some degree. The amount of change varies from person to person. Your retina specialist will advise you to wait until your vision has fully stabilized, often several months after surgery, before updating your glasses or contact lens prescription.
Re-detachment is possible, though the majority of scleral buckle surgeries are successful on the first attempt. The most common cause of re-detachment is proliferative vitreoretinopathy (PVR), a process in which scar tissue forms on the retinal surface after a detachment. If re-detachment does occur, additional surgery is generally recommended. This is one reason consistent follow-up visits are important, since early detection of a problem leads to better outcomes.
In the large majority of patients, the scleral buckle stays in place for life without causing any problems. It does not wear out or need to be replaced. Removal is only considered when a specific complication arises, such as infection, extrusion, or persistent double vision. If your retina specialist does recommend removal at some point, that conversation will include a full discussion of the reasons, risks, and what to expect.
You generally cannot judge retinal reattachment based on symptoms alone, which is why follow-up appointments are scheduled frequently after surgery. Your retina specialist uses dilated exams and imaging such as OCT to confirm reattachment and track progress. Gradual visual improvement is often a positive sign, but vision can remain blurry for weeks even when healing is proceeding normally. Report any sudden worsening of vision or new symptoms immediately rather than waiting for a scheduled visit.
Yes. While vitrectomy has become more widely used for certain types of retinal detachment, scleral buckling remains a well-supported and effective first-choice treatment for specific patient profiles, particularly younger patients with uncomplicated rhegmatogenous detachments and an intact natural lens. In complex cases, retina specialists may use both procedures together. The decision is individualized based on the characteristics of each detachment.
The macula is the central portion of the retina responsible for sharp, detailed vision. A macula-on detachment means the macula is still attached at the time of surgery, which is associated with a better chance of recovering good central vision. A macula-off detachment means the macula has already separated, which can result in permanent changes to central vision even after a successful repair. This is one of the main reasons prompt treatment is so important, because every hour a detachment goes untreated increases the risk of the macula becoming involved.
Schedule a Retinal Evaluation at The Eye Center
Our visiting retina specialists bring fellowship-trained surgical expertise in retinal detachment repair directly to patients throughout Northern Virginia, with a dedicated retina clinic at our Lansdowne office. If you are experiencing symptoms of retinal detachment or have been referred for a retinal evaluation, we encourage you to contact The Eye Center promptly. Protecting your vision starts with an expert evaluation, and our team is here to guide you through every step of your care.