A scleral buckle is a small piece of silicone, rubber, or semi-hard plastic that an eye surgeon places on the outside of your eye to treat a retinal detachment. It works by gently pushing the wall of the eye inward, pressing it against the detached retina so the retina can reattach and heal. The buckle stays on the outside of the eye permanently in most cases, and you can’t see or feel it once you’ve healed.
How a Scleral Buckle Works
Your retina is a thin layer of tissue lining the back of your eye. It captures light and sends visual signals to your brain. When the retina pulls away from the tissue beneath it, fluid seeps through tears or holes and lifts the retina off like wallpaper peeling from a wall. Without treatment, this leads to permanent vision loss.
The scleral buckle is sutured to the sclera, the tough white outer shell of your eye. By creating a small indentation, it pushes the eye wall closer to the detached retina, closing the gap where fluid was leaking through. This relieves the pulling forces (called traction) that caused the retina to tear in the first place. At the same time, the surgeon typically uses a freezing probe to create a controlled scar around the retinal tear, which seals the edges and holds the retina in place as it heals.
What Happens During Surgery
Scleral buckle surgery is performed under local or general anesthesia, usually as an outpatient procedure. The surgeon works entirely on the outside of the eye. After making a small incision in the tissue covering the sclera, they locate the retinal tear using an indirect ophthalmoscope and mark its position.
A freezing probe is applied to the sclera at the site of each tear. This creates a controlled inflammatory reaction that eventually forms scar tissue, sealing the retinal break. The surgeon then positions the silicone buckle element over the area and sutures it to the sclera. Depending on the detachment, this might be a small sponge placed over a single tear or a band that encircles the entire eye.
In some cases, the surgeon drains fluid that has collected beneath the retina, or injects a small gas bubble into the eye to help press the retina flat while it heals. The whole procedure typically takes one to two hours.
Success Rates
Scleral buckling has a strong track record. Data from Mass Eye and Ear, one of the highest-volume retina surgery centers in the U.S., shows that about 91% of patients who had scleral buckle surgery for uncomplicated retinal detachment in 2023 had a successfully reattached retina after a single operation. Among those who needed additional procedures, the reattachment rate reached 100%.
How much vision you recover depends largely on whether the detachment reached the macula, the central area of the retina responsible for sharp, detailed vision. If the macula was still attached at the time of surgery, visual outcomes tend to be very good. If it had already detached, some degree of permanent vision change is more common, even after successful reattachment.
Scleral Buckle vs. Vitrectomy
The main alternative to a scleral buckle is a vitrectomy, where the surgeon goes inside the eye, removes the gel-like vitreous fluid, and uses gas or silicone oil to press the retina back into place. Many surgeons today choose vitrectomy for complex detachments, older patients, or cases where the vitreous gel is strongly pulling on the retina.
Scleral buckles tend to be favored for younger patients, particularly those with clear natural lenses, because vitrectomy accelerates cataract formation. In children and young adults, combining a buckle with vitrectomy produces significantly better outcomes than vitrectomy alone. A study of patients under 18 found that the one-year reattachment rate was 88.5% when the two procedures were combined, compared to 56.3% with vitrectomy alone. Younger patients are more likely to have trauma-related detachments with larger tears, making the added support of a buckle especially valuable.
Recovery Timeline
Most people recover from scleral buckle surgery within two to four weeks, though some take a bit longer. You’ll wear an eye patch for the rest of surgery day and possibly the next. Your surgeon will prescribe antibiotic drops to prevent infection, and you’ll need to limit your activities for a few days afterward.
Specific timelines vary by surgeon, so ask your provider when you can shower, return to work, drive, exercise, and swim. Soreness, redness, and swelling around the eye are normal in the first week or two. Your vision will likely be blurry initially and gradually improve as the retina settles back into position. If a gas bubble was injected, you may need to hold your head in a specific position for several days and avoid air travel until the bubble absorbs.
Possible Complications
Like any surgery, scleral buckling carries risks. The most common ones include:
- Increased nearsightedness. The buckle changes the shape of the eye slightly, which can shift your prescription. This is usually correctable with glasses.
- Double vision. The buckle can temporarily affect the muscles that move the eye, causing misalignment. This usually resolves on its own but occasionally requires treatment.
- Increased eye pressure. The buckle may raise pressure inside the eye, which your surgeon monitors during follow-up visits.
- Infection. Rare, but possible at the surgical site or inside the eye.
- Scar tissue formation. In some cases, scar tissue grows on or beneath the retina (a condition called proliferative vitreoretinopathy), which can cause the retina to detach again and require further surgery.
- Recurrent detachment. There is always a chance the retina detaches again, and additional surgery may be needed.
Is the Buckle Permanent?
Scleral buckles were originally designed to be temporary, similar to a cast for a broken bone. Over time, surgeons found that most patients tolerated them so well that removal was unnecessary, and the buckle evolved into a permanent implant. The silicone material is biocompatible, meaning your body generally accepts it without problems for decades.
That said, removal is sometimes needed. The most common reasons are extrusion (the buckle gradually works its way through the outer tissue of the eye), infection, or persistent pain. Symptoms that might signal a problem include a foreign body sensation, redness, or discomfort that develops months or years after the original surgery. If the buckle is stable and not causing symptoms, removal is considered elective rather than medically necessary. When removal is required for progressive issues like infection or tissue breakdown, it can typically be done without affecting the previously reattached retina.