The scleral buckle procedure is a common and highly effective surgical technique used to repair a detached retina. A small, permanent silicone band or sponge is placed around the outside of the eyeball, gently indenting the wall to support the retina and help it reattach. While the surgery has a high success rate, the foreign material and surgical manipulation can occasionally lead to complications. Recognizing the difference between normal post-operative healing and signs of buckle failure is important for protecting long-term vision.
Understanding Scleral Buckle Complications
Complications arise from several distinct mechanisms, categorizing the potential reasons for an unsuccessful outcome. One primary concern involves mechanical issues, where the silicone material causes problems over time. This includes buckle extrusion, where the implant moves and begins to expose itself through the outer layer of the eye, or buckle migration, where the buckle shifts from its intended position.
A second type of complication involves infectious processes, such as endophthalmitis (a severe internal eye infection) or orbital cellulitis (an infection around the eye). While rare, infection is a serious risk, often presenting with pain, redness, and discharge. The foreign silicone material can sometimes act as a nidus for infection years after the initial surgery.
The most common form of failure is biological: recurrent retinal detachment. This occurs when the retina detaches again, often because original breaks were not fully sealed, new breaks form, or scar tissue proliferates on the retinal surface, pulling it away from the eye wall. Other long-term issues include induced myopia (increased nearsightedness) and chronic double vision (diplopia) due to mechanical restriction of the eye muscles.
Distinguishing Normal Recovery from Urgent Symptoms
Following scleral buckle surgery, patients should expect a period of temporary discomfort as part of the normal healing process. Mild to moderate pain and tenderness are common during the first few days and can usually be managed with over-the-counter medication. The eye will also appear red, swollen, and may be sensitive to light (photophobia) for several weeks.
Temporary changes in vision, such as blurriness or occasional double vision, are frequently reported as the eye adjusts to the buckle’s new shape. These expected symptoms generally begin to improve significantly within the first two to four weeks post-surgery. If pain or redness gradually resolves and does not worsen suddenly, it is considered part of a successful recovery.
Urgent symptoms are those that dramatically worsen, appear suddenly after initial improvement, or manifest as severe changes in vision. For example, a mild ache transforming into severe, throbbing pain, or redness that spreads and intensifies rather than fading, signals a potential problem. Any symptom that deviates from the expected trajectory of gradual healing requires attention.
Key Symptoms Requiring Immediate Medical Attention
A sudden or significant decrease in visual acuity requires immediate medical evaluation. This loss of vision often manifests as a new shadow or a curtain-like effect moving across the field of vision, a classic sign of recurrent retinal detachment. The new onset of flashes of light (photopsia) or a dramatic increase in floaters can also indicate new retinal tears.
Severe, worsening eye pain not relieved by prescribed medication is a major red flag, potentially signaling anterior segment ischemia or a severe infection. Pain accompanied by visible, pus-like discharge or increasing swelling and warmth extending beyond the eyelid suggests an infection, such as endophthalmitis. Infections around the silicone buckle are sight-threatening and require urgent care.
Symptoms related to the physical implant include a foreign body sensation persisting beyond initial healing or the ability to feel or see a bump under the conjunctiva. Visible exposure of the silicone material (buckle extrusion) or a noticeable change in eye alignment causing persistent double vision (diplopia) also require an urgent appointment. These signs suggest the buckle is causing mechanical or infectious trouble and may need adjustment or removal.
Reporting Symptoms and Next Steps
If any urgent symptoms appear, contact the eye surgeon’s office immediately or seek emergency care if the office is unavailable. Time is often a factor, especially with symptoms indicating recurrent retinal detachment or acute infection. Patients should clearly describe the onset, severity, and nature of the symptom, noting the exact time vision loss occurred or if the pain is throbbing or constant.
Patients should also be prepared to provide a detailed account of any accompanying symptoms, such as discharge, fever, or light sensitivity. Upon examination, the doctor will likely perform a dilated eye exam and possibly diagnostic tests like an ultrasound to visualize the retina and the buckle’s position. These steps confirm the complication and determine the treatment plan.