Why Vision is Poor with Silicone Oil

Why your vision is poor following silicone oil for retinal detachment surgery.

There 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 oil is often used for repeated detachments.

Did Your Macula Detach?

One major concern with every retinal detachment is whether or not the macula becomes detached.  The macula is the most sensitive part of your retina.  It provides central vision, reading ability, color vision, etc.

One goal of retinal detachment surgery, if possible, is to fix a retinal detachment before it spreads large enough to detach the macula.

If the macula detaches, you my lose permanent central vision and/or develop distortion regardless if the surgery is successful.  Thus, if the macula detached at any time, there may be some permanent loss of vision.

Was Your Lens/Cataract Removed?

Silicone oil is rarely used during “primary” retinal detachment surgery, meaning we usually don’t use silicone oil unless the retina repeatedly detaches.  So, too, is the necessity to remove the cataract, or your natural lens, during retinal detachment surgery.

If your lens was removed, this might impact your vision, too.

Index of Refraction

This is a fancy term referring to the ability of light to be focused in oil versus water.  Light is focused differently depending upon the medium, or liquid in the eye.  For instance, replacing the natural saline solution and the vitreous (i.e. during a vitrectomy) with oil would change the power of your glasses or contacts.

Too Much Oil

Oil and water focus light differently, therefore, your vision will change simply because the medium (water/vitreous exchanged for oil).

Filling an eye with silicone oil can be tricky.  Eyes come in all sizes and therefore require different volumes of oil.   We have to use our best judgement when filling the eye with oil.

The perfect amount of oil fills the entire back of the eye and stays behind the iris.  In patients where there is no lens, too much oil can move forward through the pupil and decrease the clarity of the cornea.

Too Many Retinal Detachments

Many times eyes lose vision due to damage to the retina or cornea simply from repeated detachments and surgery.  That is, while oil may be used to prevent complete loss of the eye (often the case), there has already been permanent damage to some of the ocular tissues and, thus, poor resulting vision.

What Does This Mean?

Retinal detachments are difficult to understand.  Communication with your doctor is essential, though I realize we doctors vary in our ability communicate effectively.

Silicone oil is often used as a last resort to prevent further operations.  As you can see from the list above, just by putting oil in the eye, the vision is reduced.  This fact, coupled with the necessity for future surgery to remove the oil, prevents most of us from using oil during the initial surgery.

There is a difference between successful surgery, i.e. getting the retina fixed, and seeing well.  They don’t always go hand in hand, especially in cases where there have been repeated retinal detachments….the most common use of oil.

In the end, ask your doctor why she thinks you are not seeing.  If the answer you are receiving does not make sense to you, seek a second opinion.  You have a right to understand.

 

 



Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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Comments

  1. BC,

    Without a doubt a second opinion may be helpful to you. It may not change the course of your eye, but it may help you have a better understanding of what’s going on. Clearly, you and your present retina specialist need to connect.

    Randy

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

  2. Hi doc why did I developed floaters after a focal laser macular edema treatment my doc said that they will eventually go away but I’m not sure now these is my left eye and the only I eye I can see good from I’m 29 years old and I’ve being diabetic for 15 years now on December 25 2013 I woke up with some blocking my right eye vision and I rushed my self to the e.r and was told I had a vitreous hemorrhage so they reffered to a retinal especialist I got injection treatment in both eyes and the laser treatment in my left eye my doc wanted to wait for my blood from my right eye to absorve it self but then on my next visit I told him that I felt that the bleeding was increasing so he did a scan and agreed there was a lot more blood so he scheduled me for a vitrectomy surgery the morning after the surgery he explained to me that he had problem removing the blood because it was really orgaanize and stuck to my retinah he said it was a rare case and ask if some one had punch me in the face my answer was no .so he said do to that he had to bring part of my retina with him and injected sillicon oil I only had to face down one day I got a follow up two weeks after and he checked and it was a good start up and wanted to see me in one month that month came yesterday with a bad news he said my retina is lifting up and most likely I will have to go for a second surgery but he wants to monitor it for one more week now I’m clue less and live day by day thinking what’s going to happend ……what’s is more likely for him to do in this new coming surgery????? Now I dont think his paying much attention to my left eye anymore I keep telling him I still have floaters its being two months since I developed them …will they ever go away or is it a sing of something else?? plz help

  3. Marco,

    I really can’t help you with your questions as I can’t examine you. The floaters could be blood or be related to a retinal detachment. I have no idea. I would ask your doctor if he/she feels your retina is detaching and is the cause for additional surgery.

    I wish I could help more!

    Randy

  4. Thanx doc Wong unlucky the next day I posted my questions I was watching tv and I started to see really foggy from my left eye we’re I have the floters and since my wife was cooking I ask her to open the doors and windows but she said it looks normal in here so I got worried and went out while her saying r ok I said i dont now something is not right so I ask her to take me to a store since they have more bright lights so I walked in n out and I told her take me to the e.r im sure something is going on so we went and I was told iwas a new hemorrhage and they made an appointment with a random optomologist the next morning so she checked and said theirs deffecnetly new blood floating in there she only suggested me to follow up with my normal optomologist doc and that he will decide what to do but that most likely I was going to get a new operation now when I notice this chance the blood seen really darker than right I will say it decrease a lol bit but im not sure I just have to wait to see my doc .I also have to say that the of my last visit with my optomologist I told him to check my left eye but it wasn’t dilated so he said lets do it on ur next visit and the next day its when this happen now I think that maybe if he would had checked ill be doing ok right now ..thx for ur reply

  5. Marco,

    A vitreous hemorrhage from diabetic retinopathy can sometimes take a while (weeks) to stop. Stay well.

    r

  6. omololu says:

    can I see with silicon oil on my eye and when can i start having sex after the retinal discharge operation

  7. Hello, Dr. Wong,

    I had a vitrectomy a month ago…There were numerous complications, because the trocar popped out from my eye toward the end of surgery, which caused a tear the surgeon didn’t see at the time. This lead to hypotony and choroidal detachment (treated successfully with atropine) then a retinal tear at one site (treated successfully with a gas bubble.) Then just three days ago, I noticed huge scotomas developing. I returned to the retina specialist, and learned I had a detached retina, resulting from a tear at the site of the trocar insertion (a different site from the previously treated tear.)

    The ophthalmologist initially attempted to treat it with a gas bubble, but the detachment continued to progress to my central vision. I had emergency surgery yesterday, using silicone. The retina was detached for 4 days before the surgery.

    My questions, and I know it’s impossible for you to answer without seeing me but I’d appreciate any thoughts you might have:
    First, how often does a trocar pop out from the eye? Is this a result of faulty equipment? Or my eye? Or surgical technique?
    Second, I have started to develop a cataract from all the surgery, the gas and oil. Do surgeons ever remove cataracts at the same time they remove silicone, or would this have to be two separate operations?
    Third, obviously my vision is very blurry now from the silicone and swelling, but I can no longer see the scotomas, my color perception seems decent, and I can count fingers in front of my face. Do you think this is an encouraging sign that the tear might be healing and I have not permanently lost much central vision in that eye?

    Thank you so much for your expertise!

  8. Sorry, one more question. Since the vitrectomy, I’ve been waking with black blotchy shadows in my peripheral vision and leaking into my central vision. They last for several minutes, the blotch across the top lasting even longer…I also get the blotches for a shorter time when I close my eye for more than a few seconds. They stay there till I look at a bright light, so I guess are only there when my eyes are dilated (or maybe when pressure is placed on them from my eyelid.) What could this be, and will it improve? It’s making me scared to sleep, I worry it’s a circulation issue due to the extensive laser and cryotherapy, and that by closing my eyes I’m actually causing more damage.

  9. amit malhotra says:

    I have a retina detachment surgery two month before after that the silicon oil is removed from my eye .now I have a problem of multi photo that is during the night I can see 4 to 5 light of a single light is there is some problem

  10. omololu,

    Yes, but not well. As for the sex…you are on your own, but there’s no medical reason why you can’t.

    I wish you well.

    Randy

  11. Eliza,

    Wow – difficult course.

    1. Trocars popping out happen regularly, but I don’t now how this would lead to a retinal tear.

    2. I would prefer two separate operations – just my preference.

    3. Yes, I think encouraging, but no way to really tell until oil is out.

    Randy

  12. Eliza,

    Sorry, could be for so many reasons – I’d only be guessing.

    r

  13. Thanks so much for your response, much appreciated! I’ve learned that I now have an inferior detachment, and my ophthalmologist wants to perform a scleral buckle, which terrifies me. I’ve read some research that indicates a membrane peel and vitrectomy with gas or oil may be almost as effective for inferior breaks with PVR. In your opinion, is it hopeless to think this might work, since we’ve already done one vitrectomy and the scarring will just recur?

    Also, the doctor has said several times that the buckle will be a difficult procedure because my eye is very small. Does this mean there’s more potential for complications, or complete failure? If so, I’m actually contemplating not putting my body through this, awful as it sounds to give up. The macula is attached now, but was detached for several hours during the first RD, so my prognosis is reasonably poor anyway. I’ve been dealing with issues for many months, basically living one-eyed, and if there’s not much chance of success it’s starting to not seem worth it.

    Thank you again so much. You’re so wonderful to spend your time replying to patients on this forum.

  14. Eliza,

    I’m wondering if you shouldn’t get a second opinion. If you do have PVR, a buckle may be useful. It really depends upon the amount of traction and location. There is also differences in physicians’ opinions.

    Randy

  15. Amit,

    Have no way of knowing what is causing you to see multiple images…especially because I can not examine you.

    Randy

  16. Hi Doc, I got vitrectomy after vitreous haemorrhage in my right eye, then my doctor removed silicone oil 3months afterward. It happened june 10th 2014. Now my vision is not really good, still blurry. There’re many floaters like sand. My doctor said that it doesn’t matter but I really want to know can my vision getting better, how long it takes? Tq

  17. Mega,

    Are you asking how long it will take for the floaters to disappear? No clue. Floaters can be caused by so many things, it’s hard to say without an examination.

    Best of luck,

    r

  18. Madan Bhuju says:

    Hi Doc,

    I had retinal detachment 4 months ago and my Doc use Silicon Oil to attach retina also use buckle. After 3 months Silicon Oil is removed, now it’s been 3 week after Silicon Oil remove. My vision is not clear. It is very poor.Also what i notice is object also shrink. I ask with Doc he said it can’t be improve the vision. Is they any way to improve vision? Please help me.

    Thanks

  19. Madan,

    Usually the vision with oil is poor, either due to the oil itself and/or the nature of the retinal detachment. There’s generally nothing to improve your vision with the oil remaining in the eye.

    r

  20. Madan Bhuju says:

    Thanks for reply.

    Now there is no Oil, It was removed before 3 weeks.

  21. Vijay yadav says:

    Hello sir
    I am from Nepal and am having my treatment in India
    We had exchanged email couple of weeks ago.
    I have complicated retina detachment surgery with silicone oil injected into my eyes, they also used pfcl, they also did relaxing retinotomy or something like this, i don’t know the exact term..
    TToday was my first follow up and so far is good.
    Next follow up is dated on 28th of August.
    MMy doctor said i can go home.
    SSo my question is can i take flight?
    IIt will be approx of 5 hours flight.
    OOr should I take train? It will take 3days to reach my place.
    Please tell if flight is safe or not.
    OPlease reply soon if possible
    Thank you

  22. William D says:

    Hi Dr. Wong,

    I’ve had three retinal detachment surgeries in the past four months, most recently three weeks ago, this time with silicone oil and lens removed. So basically, I can only see blurred color fields. I’m scheduled to have the oil removed and lens replaced in three months.

    Two questions:
    1. Given the fact that I’ve had 3 surgeries now, what are the likely chances of retinal detachment occurring while the oil remains in the eye during these three months?
    2. Though my lens was also removed, my vision tends to be slightly hazier than it was a week ago. Should vision normally remain constant during this time?

    thank you,
    William

  23. Madan,

    Vision is usually disappointing after oil removal. There may be some permanent loss from the detachments.

    Randy

  24. Vijay,

    If there is no gas in your eye, you should be able to fly.

    Randy

  25. William D,

    1. If the oil is presently in the eye and the retina is attached, low chance of detaching with oil.

    2. Agreed, but really can’t say why it may have changed. Make sure to keep up with your doctor. I’d be cautious about re-detaching.

    Randy

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