Silicone oil is used for recurrent retinal detachments or complicated retinal detachments including PVR (proliferative vitreoretinopathy). It can be a valuable tool to prevent blindness.
Most retinal detachments are caused by a retinal tear, or hole, in the retina. In either case, this allows for communication between the vitreous cavity and the potential space underneath the retina. Fluid may leave the vitreous and accumulate underneath the retina, causing a rhegmatogenous retinal detachment (rhegma = with a hole).
A vitrectomy with gas with or without a scleral buckle are common ways to surgically repair retinal detachments.
Recurrent Retinal Detachments
Occasionally, a retina can redetach and usually shortly after the first surgery. Common reasons include an additional retinal tear, or, it is conceivable that an extra tear(s) was overlooked and not treated.
Options include repeating the vitrectomy with gas and possibly adding a scleral buckle if one is not present. This usually does the trick.
Recurrent Detachments and PVR
Repeated retinal detachments due to additional tears usually persuades me to consider using silicone oil to fix the detachment. In addition, a condition called proliferative vitreoretinopathy (PVR) often requires using silicone oil.
PVR can cause retinal detachments as membranes (scar tissue) form on the surface of the retina and start to pull. This pulling can cause multiple retinal tears.
How Intraocular Gas Fixes Retinal Detachments
Intraocular gas works by “plugging” the retinal tears or retinal holes. The gas bubble, when properly positioned against the tear/hole, prevents fluid from getting underneath the retina causing a recurrent detachment. As the gas is absorbed, the bubble will become so small that any untreated or new hole will be uncovered. Thus, the retina can detach again.
How Silicone Oil Repairs Retinal Detachments
Think of silicone oil as a non-absorbable gas bubble. Since the silicone oil is not absorbed, it stays large enough to always cover the holes. This makes it highly unlikely that a redetachment can occur.
Is Intraocular Gas Better than Silicone Oil
Normally, intraocular gas is preferred as it eventually absorbs after reattaching the retina. A separate procedure is not required to remove the gas.
Silicone oil does require removal and the vision is usually poor with the oil in the eye, however, when warranted, the oil is likely to prevent re-detachment.
What Does This Mean?
Silicone oil is a great tool to repair retinal detachments. Repeated operations can be mentally straining and can be a hardship on the patient and family. Also, with each new detachment, the likelihood of permanent vision loss increases, thus, the fewer detachments the better.
Too many retinal physicians, using silicone oil is a last resort to keeping the retina attached. Often doctors wait until the retina has detached 3-4 times before considering oil (in fairness, I used to be one of them).
My belief is that oil should be used earlier to stop the vicious cycle of re-detachment and re-operation. By preventing recurrent detachments, the vision can be better preserved in these complicated cases.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***
Your post is exactly where I’m at Doc! Two operations, the second with silicone oil and the scleral buckle resulted in PVR. After 4 months however, everything is stable, ( very limited peripheral vision,) so we’ve decided to go in again in January to remove the scar tissue, leaving the oil in there.
I understand that the success rate for this process is about 1 out of 3, but that’s more than a decent chance to get at least some useful vision out if my eye!
Wish me luck!
My eye Dr. attached my retina to scar tissue twice and it detached both times. The 3rd operation the Dr. attached it and it now has oil in the eye. Could the retina detach again after the oil is removed. And is it normal for a Dr. to reattach the retina to scar tissue?
Thank you for all of your information regarding retinal detachment and especially this one regarding using Silicone Oil. It makes me hopeful that my last surgery with Silicone Oil will be successful although I suspect if it is not I will not be able to go through an eighth retinal surgery.
Repeated etinal surgery is so difficult physically and emotionally that it really helps being able to find such great information as you provide .
Thanks for this information. I have just had a 4th operation! there was repeated detachment, redness tears, and dischrge! What is scaring?
Thanks for keeping the information coming.
Dear Stephen,
You are welcome!
Happy Holidays!
Randy
Job,
Do you mean scar tissue?
It’s a poor description of “membranes” or a layer of tissue that lines the surface of the retina and then contracts…pulling the retina off and causing tears.
Randy
Dear Patrice,
Thank you for your kind words. Best of luck with surgery.
Happy Holidays.
r
Dear David,
The retina can absolutely detach again when the oil is removed. I don’t really understand your question re: reattaching the retina to scar tissue.
Write back!
Happy Holidays!
r
Dear Dave,
I absolutely wish you luck! Update us.
Randy
Hi Dr Wong,
I am 2 mo. post silicone oil placement for 3rd retinal detachment with development of PVR and macular pucker – all having occurred in last 4 mo. The oil is now leaking to front of eye causing severe eye pain and extremely high pressure. I was put back on multiple eye drops to control pressure and surgery is scheduled to take oil out. My eye is aphakic from last surgery. Any ideas why the oil is leaking now? Is this uncommon ? Any thoughts or advice would be appreciated.
Dear Laura,
Not an uncommon issue. With no lens, there is no physical barrier for the oil migrating forward although the oil usually prefers to stay in one uniform glob (fancy word!).
There may also be too much oil, bad head positioning, etc. I’d have to examine you.
I hope you find resolution quickly.
Randy
Dear Dr Randall,
After having silicone oil for over eight months, it was removed on 3rd January. The eye was filled with air bubble. After 8 days the bubble has become very small. However, my vision is very very faint. Glare is there in sunshine but contrast sensitivity is very poor. Is it normal? How long it would take to have reasonable vision?
Hope you have improved by now, but an eye with recently removed silicone may take a while to settle. I also can’t really address your other symptoms…there are too many factors causing glare.
Randy
The vision has come but hazy. Moreover, if i stay out in the bright day light for sometime everything becomes dark inside room and takes 8 to 10 hours to recover. I wonder why?
I had an eye(left) injury when I was 5 years old. After many operations, new lenses etc, I had a rather big retinal detachment about a year ago. My doctor attached the retina succesfully and put silicone oil in to stabilize it. It worked very well, although he was not in favour of the silicone. A year after the operation he removed the silicone and replaced it with gas. Unfortunately the gas did not work and he had to put the silicone back. My eye pressure has been very high ever since, around 38! I’m taking drops to lower the pressure, but the doctor is worried that the increase pressure from the silicone will damage my optical nerve. I would like to hear your comments on this please. Thanks
My neighbor has had silicone in his eye now for about a year and 1/2, maybe less. According to his doctor the silicone is starting to separate and they want to remove the silicone and replace it with gas. My neighbor is 75 years old. The questions I have are 1) how long is the gas suppose to last? 2) why not put in new silicone? 3) We live at an elevation of 4500. His surgery is out of town at sea elevation. The doctor wants to keep him there for 5 days after the surgery because of the difference in elevation. Would it be better to have the operation locally to avoid the elevation difference?
Dear Gerhard,
Not sure why he would associate high pressure with silicone oil. Perhaps too much oil?
I think he was saying that he is concerned about the high pressure damaging the optic nerve.
Randy
Dear Shawna,
1. The gas will last 2-4 weeks, but it depends upon the type of gas and the concentration of the gas. It varies from surgeon to surgeon.
2. I, too, would probably vote for gas, but you’d have to ask his doctor why he prefers removing the oil and replacing with gas.
3. If you can find a retina surgeon at your location/altitude. You are correct.
r
I just had surgery to remove oil after 3 months..after the 3rd detachment. An air bubble was place in my eye and is now going down and being absorbed. The vision above the line seems very blurry, which he told me it would be for a few months. My pupil has been dialated since the first surgery and has not come down at all..seems like it will be permanent. He told me it can be fixed by cataract surgeons, but I am terrified of having anyone do anything else. How poor will vision be after the 3 surgeries for detachment? Will it be blurry forever..or will a new RX for glasses help? Thanks for you comments.
dear dr wong. could you possibly say how long i can expect to wait for good vision after the silicone oil and cataract was removed from my eye.after pretty severe problems with giant tears and holes. colours are still very weird centrally with bad eye,everyone has greyish blue faces and the colour red disappears or goes a weird brown colour. also looking any distance seems like i still have the cataract. the surgeon did have difficulty with the placing the lens and it took a lot longer than i was told but the retina is still attached. also does lattice degeneration in my good eye mean that i will get a detachment on that one. he has sealed around it with laser .i have so many bits of oil floating round in my eye it’s like its raining and i’m a bit frustrated as i expected it to be a quicker result than this. thank you so much for a great site and your kindness. hazel
Susan,
I suggest you wait until ALL the gas is gone before trying to determine your eventual vision.
There are so many factors affecting your vision right now. Light bounces off the gas bubble inside your eye and can significantly reduce your vision.
Your surgeon is the best fit to answer the question about glasses.
Randy
Dear Doctor Randy:
Thank you for your advice.. Do you have any opinion about the dilated pupil issue? Would having that repaired effect the retina or be a high risk factor in another detachment? Thanks so much for your kindness.