Silicone Oil for Retinal Detachments

Silicone oil can be used to fix retinal detachments.  Using the same principles of intraocular gas to repair a retinal detachment, oil can be thought of as a non-absorbable intraocular gas.  It is a useful “tool” for difficult or recurrent retinal detachments.  Both gas and oil may, or may not, be used in retinal detachment surgery (e.g. vitrectomy and scleral buckle).

Recurrent Retinal Detachments

A recurrent retinal detachment is basically a retinal detachment that can’t be fixed.  An operation is performed, often involving intraocular gas, the gas gets reabsorbed and the retina…detaches again.  Every time the retina redetaches, more vision is lost.

“Rhegmatogenous” Retinal Detachments

“Rhegmatogenous” retinal detachments are all caused by a retinal tear or retinal hole.  By definition, “rhegma,” or a retinal tear, must be present to cause the retinal detachment.  The retinal tear allows communication with the space underneath the retina.  These are the most common type of retinal detachments.

Fluid is able to migrate from the center of the eye, through the tear to the space underneath the retina, thus, causing the retinal detachment.

Intraocular gas and silicone oil work by “plugging the hole” and stop migration of  fluid from the center of the eye to the sub-retinal space.  As long as the oil is pushing against the retinal hole causing the retinal detachment, the detachment will go away.  The oil acts like a cork.

When to Use Silicone Oil

Silicone oil is usually used after other attempts have failed.

Initial attempts at fixing retinal detachments associated with tears usually involve the injection of gas.  The gas is temporary, and will absorb within days to weeks after the operation depending upon the type of gas used.  It does not require an additional operation to remove the gas.

Advantages of Silicone Oil for Retinal Detachments

The best reason to use oil is due to the fact that it does not absorb.  This “permanancy” increases the liklihood of the retina staying attached.  It breaks up the vicious cycle of repeated retinal detachment surgery.   The whole process of having multiple retinal detachment surgeries can be mentally, physically and financially draining.

Now, I use oil earlier in my treatment algorithm.  It allows the retina to become attached, prevents redetachment and therefore saves vision!

Silicone Oil is Safe

The oil is safe and not known to cause any problems elsewhere in the body.  Some doctors feel that the oil can damage the eye directly, but this is controversial.  Many people feel the silicone oil can damage certain tissues of the eye such as the cornea and optic nerve.

I believe the oil to be safe to the eye.  There are no studies by the way, but if doctors wait too long to employ the oil, the same tissues get damaged from recurrent detachment anyway, that is, I think the actual cause of the “damage” is the mere fact of repeated retinal detachments.

What Does This Mean?

Silicone oil is a safe alternative and a good way to fix complicated retinal detachments.  For the time the oil is in place, however, the vision is usually poor, but the oil may increase the visual prognosis in the long term.

Most doctors don’t use silicone oil early enough.  They wait too long.  By then, too much vision may be lost from repeated retinal detachments.

I have found it to be more useful as I have “matured.”  As a younger doc, I was reluctant to turn to silicone oil.  I hadn’t learned that sometimes the disease wins.  My feeling is that docs should be using it earlier and not waiting until the 3rd or 4th redetachment.  It can be a wonderful tool and can buy you time as it interrupts the cycle of reoperation after reoperation.

I recently injected silicone oil into my patient with recurrent detachments in his only eye.  He is presently completely attached and is stable.  We no longer worry (for a long as the oil stays in the eye) about him redetaching.  While he may not be seeing well, we have stabilized him.

Silicone oil gives you stability and piece of mind.

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Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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Comments

  1. Grace,

    What a tough scenario. Oil can be very useful as it requires less cooperation from the patient.

    Hang in there mom!

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  2. In May this year, my husband had surgery for retinal detachment in 3 spots in one eye. The surgeon used oil instead of gas as he felt it would be more stable. My husband was able to see (20/30 in that eye) if he used a contact lens +5 and his regular eye glasses. 3 months later (Aug this year) he went back in for removal of the oil. He is unable to see out of that eye at all other than colors, blurred images. It makes no difference if he is wearing glasses or not. Will his vision improve with time? It has only been a month since his surgery but he is very concerned as it doesn’t seem to be getting better. His employer won’t let him come back to work until his vision is 20/40 with correction. What would be the reason his vision is so poor after removal of the oil when he was able to see with the oil in?

  3. Phillip Luzzi says:

    Thanks Doc for this great overview of your thoughts on silicone use in retinal detachment.

    My wife rRbyn had a haemorrage in her (R) eye 13 years ago which left her clinically blind as there was no treatment with lazer in Australia at the time that we were aware of.

    6 weeks ago she suffered a retinal detacment in her (L) eye and had lazer surgery to rectify the problem.

    After 5 weeks she developed another tear in the same eye however in a different spot. As a consequence she was rushed off to a private clinic and was operated on by a retinal surgeon who used silicone as the prognosis was very poor given that this was her only functioning eye.

    Like most doctors they have a busy schedule and the full details of the long term effects were not explained to us. It has now been six days post operatively and she has no vision at long distances, however she can see her hand about 6 inches from her face.
    We will be asking her doctor how long before she gains her vision as she is only 61 and basically blind.

    We have been told by the retinal surgeon that the silicone could be permanent as she is not a good candidate to have it removed. I hope through your experience with this procedure there are no long term effects that add further complications to her (L) eye. Thank you for the article on behalf of myself and Robyn

  4. The Dr. put silicon oil put in my eye after retina detachment and my eye is now starting to skrenk. My cornea was effected, and I asked my doctor to remove the silicon gel or oil and he would not do it. My cornea Dr. said the silicon gel is what cause my cornea to fail. I want the gel out of my eye and my cornea replaced. I had sight and now I have none. I had this surgery three years age and you can see how much my eye has skrank.

  5. Tony,

    Listen to both your docs. Sounds like you are getting good advice.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  6. Loundeann,

    There are so many reasons why he may not see; does he have a lens, and if so, has he developed a cataract?

    There could also be damage from the original detachment, formation of an epiretinal membrane.

    My ability to be more definitive is limited to the lack of an exam.

    All the best.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  7. Phillip,

    All I can say is that the decreased vision may be due to the silicone oil or the retinal detachment. I don’t know if the retinal detachment affected her central vision before the operation. Even so, no way to tell from my vantage point.

    I don’t believe the oil needs to remain for very long, but I am not her doctor.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  8. Marsha Hubbard says:

    In April 2013, I had a retinal tear and received laser surgery. Eventually, a second laser surgery was performed (deeper into my eye) in case the doctor missed anything on the first surgery. This situation held for 4 months until August, 2013, at which time my retina detached. I had surgery to remove the vitreous gel, and gas was injected, and the scleral buckle was added. Exactly one month later, Sept 2013, my retina detached again. The doctor injected the Silicone oil. In my recent follow-up visit in November, 2013, the doctor took one look inside my eye and announced we could not remove the oil or I would detach again. He wants to leave things alone until Jan/Feb 2014. Two symptoms that have occurred during this journey is that my eye has shrunk some, and my upper eyelid has not returned to its original shape. People take one look and know there is something physically wrong with my eye. My two questions are: First, have you experienced, with any of your other patients, this side effect that the eyelid is misshapen and doesn’t appear to be returning to its normal form? And, secondly, from what you’ve read about my journey, do you project that I might need Silicone Oil forever, in order to avoid future detachments. Do you have some patients that will require the Oil forever? I currently can see colors, but images are blurry and I cannot make out facial features. I cannot see anything up close.

  9. Dear Marsha,

    My best guess is that your eye “looks” smaller, but is not. This would be consistent with your eyelid drooping, too.

    Often, especially with protracted surgery or repeated surgery involving a scleral buckle, there is loss of the orbital fat behind the eyeball. Basically, there is less volume to fill the eye socket. The eyeball doesn’t push outward as much giving the appearance of a shrunken eye and droopy lid.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  10. aamir ali says:

    my Father got retinal detachment problem then the doctor in karachi Pakistan done following procedures
    1. he used silicon oil for detachment and my father hace clear vision
    2. then after two years dr said because of the silicon oil cornea will be damaged so they have decided to remove it known as ROSO(romoval of silicon oil )
    3. with in a week of ROSO procedure again retina detached , and then same procedure repeats but now my father doesnt have a vision

  11. aamir ali,

    Retinal detachments are sometimes very difficult to repair and with disappointing results.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  12. Yeoun Jin Kim says:

    Dear Randy
    My 16 yr old son got retina detachment and had a surgery 5 days ago. The choice was silicone oil since the retina tear happened long time ago and the macula region was off. I have some questions.
    Doctor did not mentioned any special head position after surgery. Is it normal for silicone oil option?
    He still sees distortion in his vision and black area. His doctor explained that it is due to the many optical changes in the eye such as stitches, laser, scar etc…and it may improve. But the info from internet were very discouraging and scary. Is it still possible to fix the distorted vision even in the case of macula off as my son’s?
    Also he is now very sensitive to the light….is it common post surgery symptom?

    Thank you very much.
    YeounJin

  13. Dear Dr. Wong
    I am 22 years old.around 4 years ago i got an eye surgery for filling silicone oil in it.and till now oil is in my eye.i am comfortable with that but some time my eye get red due to continuesly watching tv or computer.and some time due to not sleeping timely.So i just want to ask that,is it normal or should i go to the doctor for this.
    Thanks in advance

  14. YeounJin,

    I usually recommend head positioning with both gas and silicone oil (think of silicone oil as a non-absorbable gas, both are lighter than water). Head positioning, however, is dictated by the location of the retinal tear/hole which caused the retinal detachment.

    With regard to the distortion, I really don’t know all the factors and lack the ability to examine your son. It may be too early to know if the distortion is permanent. If the macular was indeed involved, and for a long time, the distortion may be a problem.

    Best of luck and thanks for commenting.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  15. kapil,

    I have to recommend you see your doctor. Redness of the eye can be simple or complex and dangerous.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  16. Phil Angel says:

    Dear Dr. Wong,
    I have amblyopia in my left eye. My right eye has started having retinal detachment problems. On 2/3/14 I had surgery to reattach my retina. Then on March 29, I noticed a spot, and the spot grew to complete darkness. On 4/1, I had a 2nd surgery with a buckle put in. I still see a gas bubble, and now the surgeon is seeing fluid around the scar tissue. He is contplating a silicon oil surgery. Are ther alternatives? I only have vision in my right eye.

  17. Dear Phil,

    Really difficult for me to say anything constructive without the ability to examine you. I would encourage you to follow your doctor’s recommendations.

    In my opinion, oil reduces the chances of re-detachment, especially if you’ve got PVR (you need to ask). Doctors overuse the word “scar” so I don’t know how it may be used in your context.

    Randy

  18. Workneh says:

    I had undergone a retinal Detachment surgery had PPV operation with silicon oil implant. In india my doctor advices me to have a laser treatment back home & the oil should be removed after six month time .my home eye specialist recommends that the oil should stay in my eye at least one year time because the retina will redetach again .I donot have a laser treat so far & I am of the opinion to travel to India for the oil removal after nine months time .what do U pse advise me?thank U so much

  19. Workneh,

    Very difficult to say. I usually consider removing oil after 3 months…if I feel the vision may improve substantially.

    I always treat with laser. I disagree that you have a greater chance of detaching at 3 mos vs. 6 mos. I say you have the same chance.

    Hope this helps.
    Randy

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  1. [...] are many reasons why you may not see well after silicone oil is used for your retinal detachment eye surgery.  Remember, retinal detachments are potentially blinding conditions and silicone [...]

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