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Protruding Scleral Buckle: Causes, Symptoms, and Treatment
What Is Scleral Buckle Protrusion?
Understanding how a scleral buckle works makes it easier to understand how and why protrusion can occur years after the original surgery. The sections below explain the basics of the buckle itself and what happens when the surrounding tissue begins to break down.
A scleral buckle is a piece of solid silicone material that a retina specialist attaches to the outer wall of the eye, which is called the sclera. By gently pressing the wall of the eye inward, the buckle helps a detached retina settle back into its correct position against the inside of the eye. The buckle is typically left in place permanently and is covered by the conjunctiva, the thin, transparent tissue on the eye's surface.
Over time, the layers of tissue covering the buckle can slowly thin and break down. When this occurs, the buckle may begin to push through the conjunctiva, becoming visible or palpable on the surface of the eye. This process is sometimes referred to as erosion or exposure.
Erosion usually develops gradually rather than suddenly. It can be driven by persistent low-grade inflammation, mechanical friction from blinking, reduced tear film stability, or thinning of the conjunctival tissue. In most cases, this is a slow process with no single triggering event.
Scleral buckle removal due to protrusion or related problems is needed in roughly five to six percent of cases over a ten-year period. Exposure and infection are the most common reasons removal becomes necessary. Erosion tends to occur most frequently in the upper portions of the eye. While this complication affects a minority of patients, it is one of the primary reasons that long-term follow-up after retinal detachment surgery remains so important.
Risk Factors for Scleral Buckle Protrusion
Several factors can raise a person's chance of developing buckle protrusion over time. Some are related to the original surgery, while others are connected to overall health and healing ability.
Certain aspects of the original retinal detachment surgery can increase the likelihood of protrusion developing later.
- More complex surgeries that require greater tissue handling
- Use of multiple buckling elements on the same eye
- Incorrect placement or over-tightening of the buckle at the time of surgery
The type of implant material also plays a role. Older sponge-type implants were historically associated with higher rates of infection compared to solid silicone bands and tires, which are more widely used today.
Underlying health conditions can impair the body's ability to heal the tissue surrounding the implant. Diabetes is a particularly important risk factor because it can slow wound healing and increase susceptibility to infection. Long-term use of topical eye medications may also contribute to conjunctival thinning over time. Patients with weakened immune systems, or those taking immunosuppressive medications, may face an elevated risk as well.
Physical trauma to the eye after scleral buckle surgery can disrupt healing tissue and accelerate erosion. When the original retinal detachment itself was caused by trauma, buckle complications may also be more likely. These factors do not make protrusion inevitable, but they help identify which patients benefit most from closer long-term monitoring.
Signs and Symptoms to Watch For
Symptoms of buckle protrusion vary from person to person. Some patients notice clear warning signs early on, while others feel nothing at all until a problem is found during a routine examination.
Many patients notice discomfort or irritation before the protrusion becomes visible to the eye. Common symptoms associated with scleral buckle protrusion include the following.
- Eye pain, which is the most frequently reported symptom
- Redness of the eye
- Tearing or excessive watering
- A foreign body sensation, as if something is stuck in the eye
- Decreased vision in the affected eye
If any of these symptoms develop in an eye that has previously had scleral buckle surgery, contacting a retina specialist promptly is important.
When a buckle becomes exposed through the conjunctiva, the risk of infection at that site increases meaningfully. Signs that infection may be developing include discharge from the eye, increasing redness, swelling of the eyelids, and pain that worsens rather than improves. Bacterial cultures have been found to be positive in a significant share of eyes that required buckle removal due to exposure or infection, which is why early evaluation matters so much.
Some patients with a protruding buckle experience no symptoms at all. In these cases, the protrusion may only be discovered during a routine follow-up eye exam. This is one of the most important reasons to continue seeing a retina specialist regularly after scleral buckle surgery, even when the eye feels completely normal.
How Scleral Buckle Protrusion Is Diagnosed
Diagnosis begins with a careful clinical examination and may be supplemented by additional testing depending on what the retina specialist finds during the visit.
A retina specialist can often identify a protruding scleral buckle by carefully examining the surface of the eye. The buckle may appear as a raised area beneath the conjunctiva or may be directly visible through a break in the tissue. The specialist will assess how far erosion has progressed, evaluate the tissue for signs of infection, and assess the overall health of the surrounding structures.
When infection is suspected, the retina specialist may collect a small sample from the exposed buckle site. This is done by gently swabbing the area so the sample can be tested for bacteria or other organisms. Lab results guide the selection of the most effective antibiotic treatment. One antibiotic frequently used as a first-line option is ciprofloxacin, which has shown strong activity against the organisms most commonly found at infected buckle sites.
Because any treatment plan must account for the health of the retina, imaging is often part of the diagnostic process. Ultrasound and optical coherence tomography (a non-invasive scan that creates detailed, cross-sectional images of the retinal layers) can help confirm whether the retina remains properly attached and healthy. This information is critical when deciding whether buckle removal is safe and whether additional procedures may be needed at the same time.
Treatment Options for Scleral Buckle Protrusion
The most appropriate treatment depends on whether symptoms are present, whether infection has developed, and the current condition of the retina. Options range from careful monitoring to surgical removal, with the retina specialist guiding each decision based on individual patient factors.
If a protruding buckle is found during a routine exam and the patient has no symptoms, careful observation may be the most appropriate initial approach. The retina specialist will schedule more frequent follow-up visits to monitor for any progression of erosion or development of new symptoms. This approach avoids unnecessary surgery while keeping a close watch on the condition over time.
When infection is present or suspected, treatment typically begins with antibiotics. Topical antibiotic eye drops are commonly prescribed, and oral antibiotics may be added depending on the severity of the infection. The initial antibiotic choice may be adjusted once laboratory culture results are available, allowing for a more targeted approach tailored to the specific organisms involved.
Surgical removal of the scleral buckle is the definitive treatment when symptoms are present. The leading reasons for removal include buckle exposure through the conjunctiva, active infection, and double vision or eye misalignment caused by the buckle's position. The large majority of patients experience meaningful resolution of their symptoms following buckle removal, making this an effective intervention when it becomes necessary. The procedure is performed in an operating room by a retina specialist.
After the buckle is removed, the area where it was attached may have a thinned or weakened area on the sclera that requires repair. The retina specialist will address this during the same procedure using one of several techniques depending on the size and location of the defect.
- Cyanoacrylate glue, a medical-grade tissue adhesive, used to seal small defects
- Scleral imbrication, which involves folding and suturing the remaining scleral tissue together to reinforce the area
- Scleral patch grafting, which uses donor tissue to strengthen and rebuild a weakened portion of the sclera
The specific technique chosen will depend on the extent of the defect and the overall condition of the surrounding tissue at the time of surgery.
In some cases, buckle removal is performed together with a vitrectomy, which is a surgical procedure to remove the gel-like fluid inside the eye. This is most relevant when there is concern that removing the buckle could allow the retina to detach again. Research is generally reassuring on this point: when vitrectomy is performed alongside buckle removal, retinal reattachment rates are high and serious visual outcomes are uncommon. The retina specialist will discuss whether vitrectomy is appropriate based on each patient's individual circumstances.
What to Expect Before, During, and After Treatment
Whether care involves watchful monitoring or surgical removal, knowing what to expect at each stage can help reduce anxiety and prepare patients for a smoother experience.
A retina specialist will perform a thorough examination to assess the health of the retina and plan the safest surgical approach. Cultures of the exposed area are typically collected before or during the procedure. Patients should share a complete list of their current medications and any relevant health conditions, especially diabetes or immune-related diagnoses, since these can affect healing after surgery.
Buckle removal is usually performed as an outpatient procedure, meaning most patients return home the same day. After surgery, the retina specialist will prescribe antibiotic and anti-inflammatory eye drops to support healing and prevent infection. Mild discomfort, redness, and swelling are normal during the first few days. Most patients notice significant improvement in their symptoms within the first few weeks following surgery.
There is a small but real risk of retinal redetachment following buckle removal, which makes close follow-up visits during recovery essential. If redetachment does occur, it can generally be treated successfully with vitrectomy.
The majority of patients do well after scleral buckle removal. Symptom resolution rates are high, and the risk of serious complications can be meaningfully reduced with appropriate monitoring and timely treatment. The retina specialist will schedule follow-up visits at regular intervals to check the retina and confirm proper healing. Patients who have had a scleral buckle removed should plan to continue ongoing monitoring of the affected eye throughout their lifetime.
Long-Term Care After Scleral Buckle Surgery
Because protrusion can develop years or even decades after the original procedure, long-term follow-up is a permanent part of managing a scleral buckle. The habits and practices described below support the best possible outcomes over time.
Many cases of buckle protrusion are discovered during routine exams before any symptoms have appeared. Finding a problem early gives the retina specialist more treatment options and generally leads to a more straightforward course of care. Even when the eye feels comfortable and vision appears stable, regular examinations remain an important and necessary part of life after scleral buckle surgery.
Patients can take practical steps to support their eye health between appointments. Protecting the eye from physical trauma, actively managing systemic health conditions such as diabetes, and using prescribed eye drops exactly as directed all contribute to better long-term outcomes. Reporting any new or unusual symptoms to a retina specialist promptly, rather than waiting for the next scheduled visit, can make a meaningful difference in how a developing complication is managed.
When to Contact a Retina Specialist
Some symptoms after scleral buckle surgery require urgent evaluation, while others call for a timely but non-emergency appointment. Understanding the difference helps patients act at the right moment.
Contact a retina specialist or go to an emergency room immediately if you experience any of the following symptoms in an eye that has had scleral buckle surgery.
- Sudden loss of vision in the affected eye
- A new shadow, dark curtain, or veil across your field of vision
- A sudden significant increase in flashes of light
- A sudden and dramatic increase in floaters, which are spots or shapes that drift across your vision
These symptoms may indicate a retinal detachment, which requires immediate treatment to have the best chance of protecting vision.
Other symptoms are not necessarily emergencies but should still prompt a call to your retina specialist without long delay. Persistent or worsening eye pain, redness that does not improve over several days, a persistent feeling that something is in the eye, unusual discharge, or new tearing should all be reported. Even mild discomfort that lasts more than a few days is worth mentioning. Identifying buckle protrusion early expands treatment options and leads to better outcomes overall.
Frequently Asked Questions
The following questions address common concerns that patients raise after learning they may have scleral buckle protrusion. If you have a question not covered here, our care team is available to help.
When erosion is minimal and there are no symptoms or signs of infection, a retina specialist may choose monitoring over immediate surgery. This is a reasonable approach for carefully selected patients, but it requires consistent follow-up to catch any progression early. Tissue erosion does not reverse on its own. Once symptoms develop or infection appears, buckle removal becomes necessary. Delaying treatment in symptomatic or infected cases can allow complications to worsen and become more difficult to manage.
There is a real but small risk of retinal redetachment after buckle removal. The actual risk depends on individual factors such as how long ago the original surgery was performed and how stable the retina currently appears. Before recommending removal, a retina specialist will evaluate the retina closely and may plan for a concurrent vitrectomy if there is meaningful concern about redetachment. When redetachment does occur following removal, it can usually be repaired successfully with additional surgery.
There is no predictable window. Some cases of infection become apparent within the first several weeks after the original buckle surgery. Erosion-related protrusion, however, often takes far longer, developing years or even decades after the procedure. Because the timeline is so unpredictable, routine follow-up appointments with a retina specialist should continue throughout a patient's lifetime, not just in the period immediately following surgery. This ongoing relationship is what allows early detection before symptoms even begin.
Buckle removal is generally less complex than the original scleral buckling procedure and is typically performed on an outpatient basis under local or general anesthesia. Most patients recover within a few weeks. When vitrectomy is performed at the same time, the procedure is more involved, but it remains a routine operation for a fellowship-trained vitreoretinal surgeon with experience in complex retinal cases. Your care team will explain what to expect in specific terms before any procedure is scheduled.
Once a buckle becomes visible through a break in the conjunctiva, the risk of bacterial infection at that site increases substantially. A significant portion of eyes requiring buckle removal for exposure are found to have positive bacterial cultures at the time of the procedure. This is why any suspicion that a buckle may be exposed warrants prompt evaluation rather than a wait-and-see approach. Early identification and treatment of exposure significantly reduces the chance of infection progressing to a more serious stage.
Expert Retina Care Across Connecticut
At New England Retina Associates, our fellowship-trained vitreoretinal surgeons have extensive experience diagnosing and managing scleral buckle complications, including protrusion, erosion, and infection. We understand that discovering a potential complication years after surgery can feel unsettling, and our team is here to provide clear answers, thorough evaluation, and individualized care. If you have concerns about a prior scleral buckle or any change in your vision, we encourage you to reach out to schedule an appointment at one of our offices throughout Connecticut.
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