Scleral Buckle: What Patients Need to Know

A scleral buckle is an operation used to repair certain types of retinal detachment. A retinal surgeon places a small silicone band or sponge around the outside of the eye to relieve traction on the retina and support it as it heals back into place.

Overview: What Is a Scleral Buckle?

A scleral buckle is a surgical device used to repair a retinal detachment. The retina is the light-sensitive layer of tissue lining the back of the eye. When it separates from the tissue beneath it, it cannot function normally and may lose its blood and nutrient supply. Prompt treatment is important because an untreated retinal detachment can lead to permanent vision loss.

During scleral buckle surgery, an ophthalmologist who specializes in retinal conditions attaches a flexible silicone band, sponge, or both to the sclera, the white outer wall of the eye. The material gently indents the eye wall inward. This reduces the pulling force that caused a retinal tear and brings the eye wall closer to the detached retina, helping the retina seal and reattach.

The buckle is outside the eye, so it is not visible to other people after healing in most cases. It is generally designed to stay in place long term. Scleral buckling has been used for many years and remains an important option for selected retinal detachments, particularly in some younger people and in detachments caused by a retinal tear without extensive scarring.

Why Retinal Detachment Happens

Most retinal detachments treated with a scleral buckle are rhegmatogenous retinal detachments. These occur when a tear or hole develops in the retina. Fluid from inside the eye can then pass through the opening and collect underneath the retina, separating it from the supporting tissue below.

Retinal tears may develop as the gel-like vitreous inside the eye changes with age and pulls away from the retina. This process is common and often harmless, but occasionally it creates a tear. Nearsightedness, previous eye surgery, eye injury, certain inherited retinal conditions, and a retinal detachment in the other eye can increase a person’s risk.

Not every retinal detachment is treated with a buckle. Tractional retinal detachment, which may occur in advanced diabetic eye disease, and exudative retinal detachment, caused by fluid leakage beneath the retina without a tear, require different approaches. The retinal surgeon determines the cause, location, and extent of the detachment before recommending treatment.

A retinal detachment is different from a posterior vitreous detachment, which is a common age-related separation of the vitreous gel from the retina. Although a posterior vitreous detachment may cause flashes or floaters, it does not always damage the retina. A dilated eye examination is needed to distinguish these conditions safely.

How Doctors Decide Whether a Buckle Is Suitable

The choice of retinal detachment repair is individualized. A scleral buckle can be especially useful when the retinal tear is located in the outer part of the retina, when the eye’s natural lens is still present, or when a person is relatively young. It may also be selected based on the pattern of the detachment and the surgeon’s assessment of vitreous traction.

Other procedures include pneumatic retinopexy, vitrectomy, or a combination of techniques. Pneumatic retinopexy uses a gas bubble injected into the eye to help close selected tears. Vitrectomy involves removing some or all of the vitreous gel and may include placement of gas or silicone oil. Each approach has potential benefits and limitations, and the most appropriate option is the one that best addresses the individual eye.

Before surgery, the ophthalmologist usually checks visual acuity, eye pressure, and the retina through dilated pupils. Imaging such as ocular ultrasound may be used if bleeding, cataract, or another issue prevents a clear view of the retina. The team also reviews medical conditions, current medicines, allergies, and previous eye operations to plan anesthesia and aftercare safely.

The timing of treatment depends on the findings. A retinal detachment is considered an eye emergency, but the urgency may differ depending on whether the macula, the central part of the retina responsible for sharp detailed vision, is still attached. The surgeon will explain the recommended timeframe and why it matters.

What Happens During Scleral Buckle Surgery

Scleral buckle surgery is usually performed in an operating room under local anesthesia with sedation or under general anesthesia. The choice depends on the patient’s health, ability to remain comfortable and still, the complexity of the repair, and local clinical practice. The eye is numbed and carefully prepared to reduce infection risk.

The surgeon makes a small opening in the conjunctiva, the clear membrane covering the white of the eye, and positions the silicone buckle around the sclera. The buckle may be a segment placed beneath the specific tear or a band that circles the eye. It is secured with fine sutures and covered again by the conjunctiva.

To seal the retinal tear, the surgeon may use cryotherapy, which creates a controlled freeze treatment on the outer eye wall, or laser treatment in selected situations. In some cases, fluid beneath the retina is drained. A gas bubble may also be placed inside the eye if additional internal support is needed. These steps depend on the anatomy of the detachment.

The operation often takes one to several hours, depending on the repair required. Most people return home the same day, though admission may sometimes be appropriate. The surgical team provides individualized instructions on eye drops, activity, positioning, and follow-up before discharge.

Recovery, Vision Changes, and Daily Care

After scleral buckle surgery, the eye may feel scratchy, tender, red, swollen, or watery for several days to weeks. Mild discomfort is common and can usually be managed with medication recommended by the surgical team. Vision is often blurred initially because of inflammation, pupil dilation, ointment, or a gas bubble if one was used.

Healing and visual recovery vary greatly. The retina may reattach successfully, yet vision may not return fully if the detachment involved the macula or had been present for a longer time. Some people notice gradual improvement over weeks or months. Others may have lasting blind spots, distortion, reduced sharpness, or difficulty in dim light despite a successful anatomical repair.

Patients are commonly prescribed antibiotic and anti-inflammatory eye drops. They should use them exactly as directed, avoid rubbing or pressing on the eye, and attend all scheduled postoperative visits. The surgeon may advise avoiding heavy lifting, strenuous activity, swimming, and dusty environments for a period of time. Driving should be avoided until vision and comfort are adequate and a clinician confirms it is safe.

If a gas bubble is used, specific head positioning may be essential to support the repaired area. Air travel and high-altitude travel are unsafe while a gas bubble remains in the eye because pressure changes can dangerously raise eye pressure. Patients should tell every healthcare professional, including anesthesiologists, about a gas bubble before receiving anesthesia or nitrous oxide.

Possible Risks and Longer-Term Follow-Up

Like all eye operations, scleral buckle surgery has potential risks. These include infection, bleeding, raised or lowered eye pressure, double vision, changes in the shape of the eye, cataract development, and discomfort from the buckle. A recurrent retinal detachment can also occur and may require further treatment.

Some people become more nearsighted after surgery because the buckle slightly changes the shape of the eye. New glasses or contact lens measurements may be needed after the eye has stabilized. Temporary double vision can occur when the tissues around the eye muscles are healing; persistent double vision is less common but should be assessed.

Rarely, the buckle can become exposed, infected, or cause ongoing irritation, and removal may be considered. Removal is not routine because the buckle may still provide support to the retina. Decisions about removal require careful evaluation by a retinal specialist, as there can be a risk of retinal redetachment in some circumstances.

Regular follow-up remains important even after healing. The surgeon checks that the retina is attached, monitors eye pressure, and looks for cataract or changes in the other eye. People who have had a retinal detachment should also be aware of symptoms that could indicate a new tear or detachment in either eye.

When to Seek Medical Care

Anyone who develops a sudden shower of new floaters, flashes of light, a dark curtain or shadow across vision, a missing area of vision, or sudden worsening eyesight should seek urgent assessment by an eye doctor or emergency eye service. These symptoms do not always mean retinal detachment, but they should not be monitored at home because timely examination can protect vision.

After scleral buckle surgery, patients should contact their surgical team promptly for increasing pain, worsening redness or swelling, pus-like discharge, nausea or vomiting with eye pain, a sudden decline in vision, new flashes or floaters, or a new curtain-like shadow. These may indicate a complication that needs rapid evaluation.

It is also important to attend follow-up appointments even if the eye feels comfortable. Retinal specialists can identify healing concerns, pressure changes, or recurrent detachment before they cause more noticeable symptoms. Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals diagnose and treat retinal conditions for international patients.

Frequently asked questions

Is scleral buckle surgery painful?

The operation is performed with anesthesia, so pain during surgery should be prevented. Afterward, soreness, a gritty sensation, and tenderness are common for a short period. Severe or increasing pain should be reported promptly to the surgical team.

Is a scleral buckle permanent?

In most cases, the silicone buckle is left in place permanently because it continues to support the repaired retina. It is not normally noticeable from the outside after healing. Removal is considered only if there is a specific problem, such as exposure, infection, or persistent discomfort.

How long does it take to recover from scleral buckle surgery?

Surface healing and comfort commonly improve over several weeks, but vision may take weeks to months to stabilize. Recovery depends on the size and location of the detachment, whether the macula was involved, and whether other procedures were performed. The retinal surgeon can provide the most relevant timeline for the individual case.

Can retinal detachment come back after a scleral buckle?

Yes, a retinal detachment can recur, although many repairs are successful. New or missed retinal tears, scar tissue, or changes in the vitreous can contribute to recurrence. Follow-up visits and urgent assessment of new visual symptoms are important.

Will vision be normal after a scleral buckle?

Some people regain very useful vision, while others have lasting visual changes. The outcome is strongly influenced by whether the macula detached and how long it was detached before repair. Surgery aims first to preserve and restore retinal attachment; visual recovery cannot be predicted exactly in advance.

Can a person fly after scleral buckle surgery?

Flying may be restricted if a gas bubble was placed in the eye, as altitude-related pressure changes can be dangerous. If no gas bubble was used, travel advice still depends on healing, follow-up needs, and the surgeon’s recommendations. Patients should confirm travel plans directly with their retinal team.

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.