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Scleral Buckling

What is scleral buckling?

Scleral buckling is a type of eye surgery to repair a detached retina and restore vision.

The retina is a layer of nerve cells in the back of your eye. These cells use light to send visual information to your brain. Retinal detachment happens when part or all of your retina detaches from the back inner wall of your eye. When that happens, your retina does not work normally. Part or all of your vision is lost, depending on how much of your retina detaches. If not treated right away, it can cause lifelong (permanent) vision loss.

Your eye surgeon may do scleral buckling under local or general anesthesia. During this surgery, your eye surgeon may use a freezing tool to help seal your retina back together. After that, your surgeon will use a small silicone band (scleral buckle) to hold your retina in place.

Why might I need scleral buckling?

Certain factors make it more likely that you will have a retinal detachment. These include:

  • Nearsightedness

  • Other eye disorders, such as uveitis

  • Past cataract surgery

  • Being older

Most of the time, the retinal detachment happens suddenly on its own. But in rare cases, an eye injury can cause it as well.

If you have a retinal detachment, you will likely need some sort of surgery. You might have new floaters in your eye. These look like little specks or cobwebs that float in your field of vision. These floaters can be so dense that they impair your vision. You might also have light flashes in your eye or a curtain over your field of vision.

If you have these symptoms, you may need an emergency surgery to reattach the retina. This can restore your vision.

Eye care providers sometimes treat retinal detachment with a less invasive procedure called pneumatic retinopexy. This procedure can't treat all types of retinal detachments. If you have a complex retinal detachment, you may also need another surgery called a vitrectomy. All of these methods can successfully fix a detached retina. Ask your eye care provider about the benefits and risks of all your treatment choices.

What are the risks of scleral buckling?

Most people do well with scleral buckling surgery. But complications do sometimes happen. Your risks may depend on your age, your health, and the specifics of your retinal detachment. Risks of the procedure include:

  • Scar tissue forming on or under the retina, causing another retinal detachment (proliferative vitreoretinopathy)

  • Detachment of the eye layer under your retina (the choroid)

  • Bleeding in your eye

  • Retinal incarceration

  • Infection

  • Increased nearsightedness

  • Increased pressure in your eye

  • Double vision

  • New retinal tears

There is also a risk that a retinal detachment will come back and that you will need another surgery.

How do I get ready for scleral buckling?

Ask your eye care provider what you need to do to get ready for scleral buckling surgery. Ask if you need to stop taking any medicines before the procedure. Follow any directions you are given for not eating or drinking before the surgery.

Your eye care provider may want to use special tools to shine a light in your eye and check your retina. You will need to have your eyes dilated for your eye exam. You also might have an ultrasound of your eye. This helps your eye care provider see the retinal detachment.

What happens during scleral buckling?

Talk with your eye surgeon about what to expect during your surgery. The details may vary. The surgery will be done in an operating room. In general, during the procedure:

  • You may be given medicine (anesthesia) to put you to sleep. If this is the case, you will sleep deeply during the surgery. You won't remember it afterward.

  • In other cases, you may be awake during the surgery. You will be given a medicine to help you relax. In this case, your eye care provider will use an injection to make sure you don't feel anything.

  • Your eye care provider will give you eye drops to dilate your eye.

  • Your surgeon will expose your eye, making a cut (incision) in the outer layer of your eye.

  • Your surgeon will use a special tool (ophthalmoscope) to view your retina.

  • Your surgeon will use a device to seal your retina back together. In most cases, your surgeon will do this with a freezing device that seals the retina to the inner wall of the eye.

  • Your surgeon will place a silicone band (buckle) around the outside of your eye like a belt. This helps to make sure that your retina stays in place.

  • Some fluid may be drained from under your retina.

  • An antibiotic ointment may be applied to your eye to help prevent infection.

  • You will be given a patch to cover up your eye.

What happens after scleral buckling?

Ask your eye care provider what you should expect after your surgery. In most cases, you will be able to go home the same day. Plan to have someone drive you home.

Follow your healthcare provider’s instructions about eye care. You may need to take eye drops with antibiotics to help prevent infection. Your eye may be a little sore after the procedure. But you should be able to take over-the-counter pain medicines as directed. You may need to wear an eye patch for a day or so.

You will need close follow-up care with your surgeon to see if the procedure was effective. You may have a scheduled appointment the day after the procedure. Tell your surgeon right away if you have reduced vision or more pain or swelling around your eye. If the procedure does not work, you may need to have another surgery.

Next steps

Before you agree to the test or the procedure, make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you will get the results

  • Who to call after the test or procedure if you have questions or problems

  • How much you will have to pay for the test or procedure

Medical Reviewers:

  • Chris Haupert MD
  • Tara Novick BSN MSN
  • Whitney Seltman MD