Silicone Oil for Retinal Detachments

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.

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Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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***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.***

Comments

  1. Hi Doctor Wong,

    I am 31 years old. My eye sight started weakening since he age of 12. At age of 26 I was diagnosed with cataract in both eyes, My Doc initially delayed cataract removal since it was not causing major hindrance to vision. i am also high Myopic. Doc performed cataract operation first in left eye and the in right eye with a gap of one year. I was doing quite well, until 6 months ago, I had a retinal detachment in right eye, though it was operated for cataract later than the left eye.
    I was operated for retinal detachment with silicon oil in my eye. Doc said they will remove after 6 months to one year initially, but few days back I had a “Facial Paralysis” on the left side (a mild stroke but on the other side, NOT on the retinal detachment operated side of eye, I am on steroids treatment for a week now and recovering).
    My eye specialist told me that Oil in the eye has started “Emulsification” , i am not sure what is this process and he needs to remove it now. Oil has already been in the eye for 5 months and he gave me appointment next moth for removal of silicon oil, means Oil will be completing 6 months till then.
    1.My Question is that what is the effect of facial paralysis on retinal detachment or silicon oil removal surgery.
    2.Also This was my first surgery for Retinal detachment but doc preferred to do it with silicon oil. Why?
    3.Doc described Rhegmatogenous retinal detachment type for my case.
    4.What is the emulsification of oil, what can it cause to eye and is how much should doctor wait for silicon oil removal if Oil starts emulsification.
    5. Will doc prefer to insert Gas after silicon Oil removal or not.
    6. What is average recovery time after the silicon oil removal.
    7. Is the silicon Oil removal surgery complicated like retinal detachment surgery less critical.

    Sorry for so many questions.

    Thanks alot for such a nice and informative website.

    Regards

    Ikram

  2. Dear Brian,

    There was a study several years ago where silicone oil was indeed used for macular hole surgery. You are right, in theory, the most peripheral retina may be difficult to have covered. This is especially true for the retina at “6 o’clock.”

    r

  3. Ikram,

    1. None.
    2. I don’t know, you’d need to ask him/her for the specific reasons. Perhaps it was long standing or you had evidence of PVR?
    3. Maybe very complicated by multiple holes. Again, this is a great question for your doctor.
    4. Emulsification: oil breaking down.
    5. Don’t know. Ask.
    6. Depends upon gas used, if any.
    7. In my experience, oil removal is easy.

    Thanks for the remarks about the site.

    r

  4. Dear Dr. Wong,
    My father (who resides in India) is affected by retinopathy and retinal traction. I have been trying to educate myself about the treatment options so that I can assist him in making meaningful decisions.

    He has only one functional eye on which vitrectotomy and silicon oil placement were performed 3 months ago. The oil had stabilized his retina until now and his intraocular pressure was under control.

    But, after particularly cold winter in India and being outside during a local festival, his IOP increased > 50. He has been given Mannitol IV two times over 4 days now to relieve the pressure. His doctor is going to remove the oil in couple of days.

    I have following questions, and will be grateful for your insights.
    1. can silicon oil emulsification cause sudden increase in IOP?
    1. can cold weather induce emulsification of silicon oil and elevate IOP?
    2. can sneezing hard due to cold affect silicon oil distribution in eye and elevate IOP?
    3. After removal of silicon oil, how long does it take to regain ambulatory vision? After vitrectomy, the recovery lasted for 10 days or so during which oil drops needed to be administered. My father gained ambulatory vision in about a month.

    Lastly, I want to thank you for the great service you are doing to community at large by allowing them to write to you.

  5. Dear Shalin,

    1. Usually not
    2. No
    3. No
    4. Depends upon the vision before the oil was inserted. Your doctor should be able to tell if there is likely improvement within a week or two.

    Thanks for the support and kind remarks!

    Randy

  6. Dear Shalin,

    Is your dad diabetic? I would think the diabetic retinopathy is likely to cause the IOP changes, but ask his doc.

    r

  7. Dear Dr. Wong,
    Thank you for your views. My father has diabetic retinopathy. He has been affected by chronic glaucoma since many years, but this was the first episode of acute glaucoma as far as I can recall; so I wanted to understand what may be underlying cause. After examination, his doctor did laser iridectomy, which has helped so far and we have postponed removal of silicone oil.

    Shalin

  8. Dear Shalin,

    Laser iridectomy, in this specific case, may be due to the silicone oil blocking the pupil. Aqueous humor is then prevented from moving to the front of the eye and can’t leave the eye….thus, the pressure increases.

    r

  9. Michael says:

    Dr Wong:

    I recently underwent a third vitrectomy since early March. Following the first reattachment, PVR formation caused subsequent detachments in early April (4 weeks after the original surgery), and then again at the end of April (2 1/2 weeks after the second operation). In operation #2, I received a scleral buckle. This last time, I had a small part of the bottom of my retina cut away (where the scarring was forming), and received silicone oil. A one-week followup showed the retina reattachment is holding well and there is no sign of new scarring.

    I’m in a waiting period now — but wonder how soon PVR would be noticeable if it were to return? I have an opportunity to fly to Washington for a conference in two weeks, and I’m nervous about being out of town if I’m likely to have another detachment. My doctor says I shouldn’t worry about going — as a detachment will occur whether I travel or not if it’s going to happen. If it happens in Washington, he says I could be seen there (or I could try to rebook an immediate flight home).

    So I’m wondering if I am needlessly worrying about a recurrence, or if it’s a wiser course to stay closer to home and my usual medical care for the next couple of months?

    Thanks.

  10. Dear Michael,

    1. PVR will burn out at some point. I usually feel that PVR is stable if the retina remains attached after a few weeks with oil, that is, if you were my patient, you should be fine with travel.

    2. Fairfax is 20 minutes from Washington DC.

    3. I think you will okay traveling.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

  11. Dr Wong,

    I did retinal detachment surgery and cataract in the same time before 3 years (28/08/2010) by silicone oil, then after four months the oil removed (25/12/2010), but there were still some small bubbles of oil in the eye the eye was good around 17mmHg but after one year the pressure of my eye increased around 24mmHg and some doctors told me maybe due to the oil bubbles i am using now COSPOT drops and the eye pressure become normal around 17mmHg …
    i am confused shall i do another surgery to remove the remaining small bubbles or no need .. to be honest with you some doctors told me no need and some of them they told me do it?
    is there any risk to keep these small bubbles forever?

    Br,Sean

  12. Sean,

    Silicone oil should not react with the tissues in the eye. I doubt small bubble could be directly causing an increase in your eye pressure.

    I don’t think there is any long term risk with the small bubbles.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

  13. Hello Doctor
    I had etinal detachment surgury with buckle and bubble then has a lower detachment oil used still in attached. I’m having surgury to remove oil that’s beer. In since 2010 I’m nervous about it and concerned about recovery period time etc. I want to do because vision with oil is not clear no lens in either. Please share your words of wisdom as to what to expect with oil removal and possible outcomes
    Thanks

  14. Luis,

    I personally hate removing oil due to the possibility of recurrent retinal detachment. I estimate there is about a 50% chance of this happening. I usually pretreat the retina with laser about 1 month prior to the anticipated removal….to reduce the chances of redetachment.

    Randy

  15. Addie Reed says:

    Hi there, My husband on May13 2003 had a gas bubble put in. The next Monday pain was so
    bad they done another surgery to move blood. Did not work on Wed. the same week done another
    surgery to rmove blood and put a band around the retina then thurs. the next day went in and
    removed the band and wash the eye out again. Pain has been so bad he has lost 30 pounds and
    still no relief. So on June 13 a different Dr. in the same office put a Silcone oil bubble to help the
    bleeding. Is this a normal thing to happen are the messing up. They told him his eye was
    weak because of near sightedness and the other surgeries he has had done. A need to know. So so
    sad he is still in pain. Pain pills do not help much it seems. My husband is not a whimp. Takes pain
    better then most. So what is the answer. Ar

  16. Addie,

    This seems really, really complicated. Eye issues, especially retina, can become complex, but this seems unusual.

    Where are you located?

    Randy

  17. Randy:

    I had a vitrectomy/reinectomy with oil here in Wisconsin in May to reattach my retina for a third time (PVR troubles) and I’m coming up on my appointment next month to evaluate progress and maybe plan to have the oil removed. I haven’t been able to find any information about the procedure — how long that surgery lasts, and what I can expect afterwards as far as recovery time, being out of work, resuming normal activities, etc.

    I have no idea how stable things are. I had no new scarring apparent after the one-month exam. I still see occasional dim flashing in the center of my vision…though that has been going on since the day after surgery and my docs have said it will likely stop.

    Also, I seem to be seeing double occasionally, which I attribute to the buckle I got after my second detachment. Is that common and is it usually treatable in some way?

    Thanks,
    Michael

  18. Michael,

    1. Surgery to remove the oil can take at last 20 minutes due to the extreme thickness of the oil.

    2. I have no idea how stable you are as I can not examine you.

    3. My usual plan would be to laser your retina in prep for the oil removal. I usually don’t plan on gas after removal unless I see something during the operation to change my mind, but your surgeon may have a different opinion.

    All the best,

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

    http://www.TotalRetina.com

  19. Hi ,

    My husband had a retinal detachment surgery in May where a gas bubble was inserted but after 3 weeks there was another detachment as the bubble could not hold the retina in place. This time in June the doctor put a silicon oil in his eye so it can better hold the retina. The silicon oil is still in his eye and with today’s doc appointment we came to know that a cataract had formed in his eye.

    Doctor said he is not sure what to do and asked us to take a second opinion. We are now confused and worried. What is the best approach to this…in order to avoid further damage to the eye.

    Thanks,
    Uma

  20. Uma,

    Hopefully you’ve gained the opinion of a second retina specialist. Doesn’t seem outwardly complicated, but I don’t really know the history nor exam of your husband’s eye.

    Doesn’t sound bad to me.

    All the best. Let me know.

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

    http://www.TotalRetina.com

  21. Hi Dr. Wong,
    My husband had very large retinal tear over the weekend. He has very bad myopia and also his mom had a detached retina. He is 49 and had a moderate cataract taken out last spring in the eye that got the tear. This is the first tear he has had, it is quite large, and getting a bit larger after some laser which was supposed to keep it in place until getting to the surgery. The retina is not detached yet, but vision is blurred. The doc is giving him a choice between oil and gas. He says the success rate is about the same. But I am not sure which is best.
    1- what is the risk for the second procedure to remove the oil.?
    2-Is it more dangerous to have two procedures instead of one? My husband is very workaholic and he is a little crazy he does not want to take four weeks off of work for the gas procedure, which is why the doc offered the oil. I do not want his crazy urge to work to harm his vision. He is at work right now, he never listens.
    3-Are the results truly the same? I am digging through trying to come up with good information on the internet. Thanks for any advice you have.

  22. Amy,

    1. I usually go with gas for the first 1-2 operations.

    2. The advantage of the gas is that a second procedure may not be needed (with oil, a second operation is needed to remove the oil).

    3. The results can be the same, but I am always interested in why some surgeons use oil during the first operation (outside of some very unusual retinal detachments).

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

    http://www.TotalRetina.com

  23. Dr. Wong,
    On 11-13-13 I went in for emergency detached retina surgery, got a buckle and silicone oil was placed in eye due to large tear. I am nearsighted had LASIK twice in my left eye and was rearended a month before this tear.
    I had unusual swellening according to the doctors and now three weeks later my eye is still blood red, seeing double vision. I’ve been off work and I’m thinking I should be off until my eye clears up.
    Feb. Is the anticipated oil removal. They say the retina is flat and looks very good.
    1. Will my retina stay intact
    2. Based on what I’m reading, it appears I will be off for a minimum of two weeks to ensure my retina stays attached.
    3. Is there swelling and bloody eyes and tears with oil removal.

  24. Emily,

    1. No guarantees. I usually wait a couple of months before removing the oil. Sounds like your doc is doing the same. Can’t tell beforehand if you’ll detach or not.

    2. Possibly. Depends if gas is put back in at the end of the operation.

    3. There can always be swelling and blood after any eye operation. My guess is that most of the swelling was due to the original buckle.

    Hope this helps.

    Thanks and Happy Holidays!

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

    http://www.TotalRetina.com

  25. Hello Dr. Wong,

    Can a patient have MRI, during she/he has silicone oil in eye?

    Thank you.

    Best regards,

    Renda

  26. Hello Dr. Wong,

    I will have MRI from my brain, so that I am worried.

    If I understood right, MRI won’t effect my eye that with silicone oil probably?

    Thank you.

    Best regards,

    Renda

  27. I had a vitrectomy in March 2013 to remove a large number of floaters that were making my life miserable. Unfortunately this turned out to be the wrong decision as I’ve now had 6 surgeries to fix recurrent retinal detachment due to PVR (this is disappointing because the original surgery went well and two months later I had a tiny tear in the periphery, but after the surgery to repair that my vision was extremely distorted — a buckle was not done and I’m not sure why??). I’m 43, and was told I was more prone to PVR.

    Anyway, the fourth surgery left me with a diagonal stripe of vision across the center and was filled was silicone oil. I think he blasted most of my retina to save the macula. The oil apparently stopped the PVR, but five months later the oil was removed in a fifth surgery and my retina detached again within two weeks. A sixth surgery was done last week, however I chose not to have the silicone oil put in. My eye has been through enough and even though the doctor wanted to keep the oil in long term, I know that it emulsifies and becomes useless after 1-2 years. I would need an “oil change” periodically the rest of my life, and since it’s impossible to see through the oil, I opted for C3F8 in a last ditch effort. I’ll know in 2-4 weeks if it will work. Hopes are high, but I’m realistic.

    Wanted to get your thoughts on long term silicone oil in the event I do decide to have one more surgery. My eye is mostly gone at this point. I am counting on stem cell therapy or retinal / visual cortex prothesis. What are your thoughts on these new technologies, and I’m really wondering if the laser scarring rules me out as a candidate for stem cell retinal regeneration. Thank you.

  28. Eric,

    Sorry to hear of more difficulties.

    I don’t believe silicone oil necessarily emulsifies and you should get your eye examined periodically to ensure there are not complications from the oil.

    Instilling the correct amount of oil is difficult for many surgeons. Often the eye gets too much oil and the need to remove the oil is blamed on “emulsification.”

    I have no idea how to answer the stem cell question….we just don’t know yet.

    Thanks for keeping in touch.

    Randy

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

    http://www.vitrectomyforfloaters.com

  29. 16 years back my mother had an RK and after that right eye was good but on the left eye my mother saw a Black hole on the center of the left eye and a doctor said that the center vision of the left eye had been damaged but side vision from the left eye was alright. Now, a few time back ( two months) my mother went to the doctor to check the eye so the doctor said that the retina has detached and the eye wall also removed, after operation the doctor used silicon oil and still the left eye is blurred , so how long is will it take to get clear vision and what’s the healing procedure here, and beneath the eye a black shadow has appeared so what should she do to heal it , she should just rub ICE over it or what?

    Thanks.

  30. Hi Dr Randall,

    I had a detachmnt surgery 2 yrs back by buckling……which was unsuccessful , then it was again operated and the silicon oil was used . Since it was almost a year n half the oil was not removed , Catract was developed .immediately the lens was placed but the oil wasn’t removed, it was removed after 2 months…..thatz now.Its 3 weeks now the is removed but my eye pressure is high GAT 28 and I have a severe head caught.I visited the dr today…….n he has again prescriped the pressure control drops.I am worried why is the pressure so high and I’m scared of again a re detachmnt occurring. Your suggestions please.

  31. Irfan,

    Blurred vision could be from both the oil AND retinal detachment. Tough to say if the blurred vision will ever clear.

    r

  32. Shilpa,

    High pressure and your retina being attached/detached are not usually causally related.

    r

  33. Dear Dr. Wong:

    Are there any adverse effects if I choose not to go through oil removal surgery. If so what are they. I do have Glaucoma since some years but it is under control by using prescribed eye drops.

    Thank you.

  34. Husein,

    Adverse effects from oil are controversial. Some say there are none whereas there may be toxicity to the optic nerve, cornea or cause glaucoma. If you were my patient, one option would be to leave the oil indefinitely and monitor frequently for complications.

    Randy

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