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Avatar universal

Eyeball sunken in after operation

I got a detached retina due to accidental force of water shooting out of garden hose into my eye.  Went to retinal specialist, had unsucessful laser surgery. Then he did a combined operation of a buckle and vitrechtomy, and put in silicone and then retina was re-attached.  I can not see out of this eye at all (however, this was a lazy eye before, and I was never really able to see well), I have extremely blurry vision and straight lines are wavy and I cannot make out what I see, I see out of the other eye, but it is mixing up my brain because I see different things out of each eye. The Dr. says I now have scar tissue forming in the center of eye, which will have to be removed with an operation, and at the same time he will take out the silicone.  I am delaying this because the operation was very difficult and painful to recover from, and I have other unrelated medical problems that I am suffering with. The main problem right now is that the eyeball has sunken in a lot and my eyelid tends to droop.  Is there anything I can do about this, another operation, or medicine? I would like to go to a different Dr. but don't know if I can be helped with the sunken eye, it is disfiguring and I see people staring at my eye.  I still have the silicone in the eye, how long can that be kept in for? I had this combined operation about two and a half years ago. Any reply will be greatly appreciated.
22 Responses
233488 tn?1310696703
MEDICAL PROFESSIONAL
You have two problems:
1. distorted vision from the eye being amblyopia, having a macula off detachment and now a macular pucker.
2. The sunken eye and droopy lid.

You need to attend to problem 1 first. The surgery is very very taxing and difficult. You can use the search feature on this page and search "macular pucker surgery" and read about it. You should probably also get a second opinion.

Only after you have the operation OR decide not to have it should you address problem 2. For that see an oculoplastic surgeon. You can ask your retina surgeon for a referral. There are operations to correct your cosmetic problems.

JCH MD
203589 tn?1267478770
Where to begin....as a patient of RD's I'd like to add my two cents.

First off, the sunken eye m not be able to be fixed depending on the cause, which may be that the eye has atrophied considerably. The drooping lid, which was more than likely caused by the buckle surgery, can be fixed w/ surgery but like any surgery carries risks. If the eye is considerably painful and otc or rx meds are not working consider pure alcohol injections and as a last resort there is enucleation.

Next, your vision may improve w/ the removal of the scar tissue from the retina and the removal of the silicone oil. This would probably help your binocular vision out. The pain that you experienced w/ the initial surgery was more than likely due to the scleral buckle as that procedure is more complex and involves sewing a piece of silicone to your eye. The removal of scar tissue and oil does not involve muscle manipulation so recovery should not be painful. Also, the silicone oil can be left in the eye indefinitely if it is deemed necessary. Depending on age and other factors this may be a good option. However, most doctors prefer to remove the oil at some point b/c doing so not only improves vision but avoids some of the complications that can arise w/ silicone oil.

Lastly, it is important to talk to your doctor and assess all the risks and benefits associated w/ any surgery. Remember to always keep your other eye safe.

Hope things go well for you and that this was at least minimally helpful.
233488 tn?1310696703
MEDICAL PROFESSIONAL
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Avatar universal
Dear Dr. Hagan: Thank you so much for your prompt answer.  The distorted vision from the eye being amblyopia is much worse than it was before I had this operation.  Prior to the operation my lazy eye did not interfere at all with my sight, as my other eye was 20/20.  I did not have this blurry double vision coming out of my lazy eye, it somehow worked alongside the good eye and I had some peripheral vision, which I no longer have. The lazy eye did not interfere with my vision, did not "mix" me up by seeing differently from both eyes at the same time. Would having this Macular pucker surgery enable me to get back to what I had -- which basically wasn't so great because I had 20/200 but it did not bother me because I didn't have the blurry or wavy vision coming out of the bad eye. The buckle and vitrectomy which I had done at the same time was not an easy operation either.  Is this Macular pucker Surgery also just as difficult, will I have to lay face down like with the Vitrectomy?  Also what are the benefits of having this surgery and do they usually take out the scarring which occured in the center of the eye at the same time? Also if I don't have this surgery, how long can I keep the silicone in, because it has been in for 2 and a half years, and I have other medical problems I am dealing with right now.  With regard to the sunken eye is there any medicine I can take instead of having the surgery.  If not, would I do all the procedures at the same time during the same surgery -- taking out the scar tissue, macular pucker surgery, silicone removal and fixing the sunken eye and droopy lid. Thank you for your patience in answering all of my questions.
Avatar universal
Thank you for your response.  The eye is not extremely painful.  The main problem is that I see differently from each eye at the same time - is that what you were referring to when you wrote "binocular vision out".  It bothers me a lot and I am probably contributing to my droopy lid because I tend to close the bad eye a lot so that I can focus better with my good eye, and my brain doesn't get mixed up.  The other main problem is mostly cosmetic, the sunken eye, do you know if there is any RX for this.  The sunken eye did not occur right away, but progressively got more and more sunken in as time passed.  Do you know if the atrophy can be reversed with vitamins, or anything else.
And Yes, I realize now how important it is to protect my eyes, I never thought that the garden hose would slip out of my hand and the force of the water would cause my retina to detach.  A warning to all -- wear sunglasses or protective glasses anytime you are doing any kind of work around the house, such as painting, hammering, watering the garden, etc.  Thanks for any advice you can give me.
233488 tn?1310696703
MEDICAL PROFESSIONAL
The prognosis to get back where you were before all this developed is not good even with surgery. THe silicon oil can remain in the eye indefinitely. Removal is up to the surgery. The only thing that might help your eye lid and sunken appearance would be injection of autologous fat behind the eye and that often doesn't work.

JCH MD
Avatar universal
In one of your posts, you wrote that you walked and saw a movie right after your vitrectomy.  I had a buckle and vitrectomy done together, and was told that I had to remain in a face down position for six days -- eating, sleeping, etc.  For me this was the hardest part aside from the pain, and reaction of my eye pressure going way up high at night after the surgery.  I need to have another vitrectomy for a macular pucker which occured after my initial surgery.  I am dreading it and have tried to delay it, but it has come to a point where both of my eyes are seeing two different things at the same time and it is very bothersome and mixing up my brain. I feel I have no choice but to go ahead and have another operation to remove the pucker, scar tissue and silicone still left inside from my previous surgery. Please advise what kind of vitrectomy did you have where you were able to go to movies, and did not have to lie face down for six days.  Also do you have any recommendations of who the best retinal surgeon in the New York area would be, since I want to go to a different Dr. even though mine was very good with answering questions, and being patient. I want to go to someone with a lot of experience in dealing with retinal detachment. By the way I do not have functional vision in the affected eye not only because of the operation, but because it was a lazy eye, and I could barely read the largest letter "E" even before my detachment problems started. I am not sure if I should have the pucker corrected, or just get the operation that removes the silicone.
What are your thoughts.  Thank you so much for answering everyone's questions with such knowledgeable answers and obvious care and concern for others.  It is very much appreciated by all, as your research and comments are educating us all.
233488 tn?1310696703
MEDICAL PROFESSIONAL
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Avatar universal
A vitrectomy is done for various reasons.  It's my understanding that face down positioning afterwards is sometimes necessary in cases of retinal detachment/macular hole in order to hold the repair together until some healing has taken place.  My retinal surgeon told me that face down positioning is almost never necessary for macular pucker surgery (where the goal is to peel off a layer of scar tissue using miniature instruments.)  I don't think your recovery from this procedure would be very difficult.  My only restriction post-vitrectomy involved avoiding heavy lifting.

I've had good luck finding eye surgeons using Castle-Connolly.  All of their doctors are board-certified, experienced, and have been nominated by other doctors as someone they would seek out for their own health problems.  Look for ophthalmologists who specializes in vitreoretinal surgery.  (You can access their data base online for $9.95 at www castleconnolly com.)  You might want to set up appointments with two (or even three) surgeons.  This would give you a chance to get recommendations and discuss all your concerns with more than one doctor.
Avatar universal
Thank you for your answer. From your research, do you know whether the surgery for macular pucker will eliminate the "celophane-like", blurry, wavy eyesight that I was left with after my buckle and vitrectomy operation. I know I will never be able to see out of the affected eye with functional vision.  What I need to achieve is to see only with my good eye and not be mixed up by seeing totally differently with the bad eye, when I look at something or someone I see two different images, and it is extremely confusing for my brain and very bothersome, I find myself closing my bad eye a lot, so that I can see better.  Will my eyes ever be able to work together as they did before I had my operation.  As I mentioned before I was never able to see with the bad eye because it was a lazy eye, but it didn't mix me up, or interfere in any way with the vision and things I was seeing with my good eye.  Also have you come across anything in your research that can be done about the operated eye that has sunken in a lot, and a droopy lid, the eye seems to be half the size of my normal eye and looks weird.  It is disfiguring and I am very depressed about it, specially when I see people staring at me, or when I see myself in photographs.  I don't know if it has atrophied and whether anything can be done now about the sunken eye, possibly something can be done when I go in to have the macular pucker operation.  Please relay any info about above questions, as I feel that you are most knowledgeable and caring. Thank you for your help.
Avatar universal
The questions you're raising about macular pucker surgery are issues to be discussed with the retinal surgeons you're going to consult.  Peeling the layer of scar tissue should certainly minimize your wavy vision to some degree.  Another possibility for eliminating the problems you're having using both eyes together might simply be to wear an opaque (cosmetic) contact lens in your bad eye (and skip the retinal surgery.)  A retinal surgeon could advise you as to what would be best in your case.

Correcting the cosmetic problems with your eye might contribute more to your quality of life than possible retinal surgery.  I think that you should consult two or three of the very best oculoplastic surgeons in New York.  As Dr. Hagan suggested, you could get referrals from the retinal surgeons you're going to see.  You could also get additional names from Castle-Connolly.  I'm sure that these specialists would have excellent recommendations for you.  You could choose the specialist who inspires the most confidence.

Very best wishes.    




  
Avatar universal
I don't really have much to add since honestly I really don't know that much but wanted to comment on your vision being wavy.  I too had surgery with a buckle and insertion of silicone oil just over a month ago.  I also had 7 days of face down fun.  I can't see straight lines out of that eye now.  Everything is a bit wavy and distorted.  It's like everything is slightly squished together.  I was told this is because I still have the oil in my eye.  I'll be having it removed in 3 to 5 months so as to reduce the likelihood of cataracts developing.  After the oil is removed and my eye starts hearing again, things shouldn't be too distorted.

So I'm thinking, if your oil isn't removed, you'll always have some degree of distortion.  Mine isn't too bad because with both eyes open, my right eye corrects for my left.  

Oh I too have a droopy eyelid, however my doesn't sound as serious as yours.  

Just want you to know you're not alone.  And wow, you really have a unique story of how your retina detached.  My retina just randomly decided that 21 years of being attached was just too many and it wanted to peace out.  
233488 tn?1310696703
MEDICAL PROFESSIONAL
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Avatar universal
Thanks. Will be seeing another retina specialist soon, after I recover from other new medical issues - tingling, pins & needles in toes, going up leg, and same in arm to fingers, I know I'll have to eventually have the operation, but in the meantime I' m going to try your suggestion of an opague contact lens in the bad eye, my Dr. also had suggested it, but I dismissed the idea because at the time my eye had just been operated on. I am having some success by wearing my glasses all the time, the bad eye doesn't interfere as much with the good eye's vision. Temporarily glasses and contact lenses will keep me out of the operating room for a while, but there is the inevitable.  I think I'll ask for general anesthesia this time, might make it better, LOL.
233488 tn?1310696703
MEDICAL PROFESSIONAL
-
Avatar universal
Did you have a problem with the eye before it detached, because my Dr. said that congenital defects in the eye could eventually lead to detached retinas. Or were you doing some kind of sports. Did you have floaters, and flashing lights principal warning signs, which I ignored for a few weeks. I want people who get these symptoms to realize that they should go to a retinal surgeon right away because time is of the essence, the sight in affected eye could be permanently affected. I'm going to need surgery for a macular pucker which developed after the operation, and I'll have silicone oil removed at same time. I'm hoping no face down fun needed after operation.
233488 tn?1310696703
MEDICAL PROFESSIONAL
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Avatar universal
You've really had more than your share of health problems and are definitely overdue for some good luck.  If wearing glasses helps right now--great!  My macular pucker surgery only lasted about 40 minutes--maybe less.  It was not painful surgery; the local anesthesia they used eliminated any sensation of pain.  I was awake and could watch--it was sort of a bizarre but interesting experience.  You could do general anesthesia, but I think you'd be fine with IV sedation (and you'd wake up sooner).  Best of luck.
233488 tn?1310696703
MEDICAL PROFESSIONAL
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Avatar universal
Thanks.  I am not a big proponent of general anesthesia, but my experience with IV sedation given during my combined buckle and vitrectomy eye operation was terrible. I was awake the whole time, could feel some pain and discomfort, but the worst was that I felt like I was suffocating and couldn't breathe, since the surgeons had my face and nose covered with all kinds of material, in order to be able to work on the eye and keep the area clean.  It may have been anxiety, I am not sure. The anesthesialogist was told to keep giving me more IV and oxygen. I remember towards the end, telling the Dr. to stop the operation I couldn't take any more as I felt that I couldn't breathe. Luckily he was almost finished, so he continued for a while longer. It is reassuring to hear that the local anethesia eliminated your sensation of pain, and that the operation didn't last longer than 40 minutes.  I usually have a high threshold for pain and can deal with it effectively, maybe when I am ready for the macular buckle surgery, I'll try IV sedation again.  Would you be able to explain to me why you needed the macular pucker surgery, was it as a result of a prior vitrectomy, was your surgery done outpatient or in the hospital with overnight stay? How long did it take you to fully recover from the surgery, swelling, etc., and also what are your results after the macular pucker surgery. Thank you for your posts.
Avatar universal
Macular pucker surgery is MUCH easier than getting a buckle.  It's almost always an outpatient procedure.  If the newer sutureless vitrectomy equipment is used, the whole procedure takes only about 20 minutes.  (It's the surgeon's option which equipment is used.  Mine used the older equipment that requires sutures.  Recovery is reported to be faster with the newer equipment.)  In either case, it is not painful surgery, and I think you'd do fine with local anesthesia and IV sedation.  That's the way it's usually done in the USA.  (They tend to skip the sedation in other parts of the world.)  You should definitely talk to the anesthesiologist about your experience during your buckle surgery and let him/her know that you don't want to be awake or remember the surgery.  You'll leave the surgery center wearing an eye patch (because of the residual effects of the local anesthesia), which will be removed by your surgeon the next morning.  The post-surgery instructions I got said that Tylenol would be more than sufficient for pain control.

It's not certain what caused my macular pucker; I've read that it occurs more frequently in people over 50.  (I was 51.)   Usually the effect on vision is limited, and no treatment is indicated.  In a minority of cases (like mine) the thin layer of scar tissue on the macula continues to increase in density, and my vision kept getting worse.  I wish I could say that my recovery was easy, but I had terrible problems with inflammation resulting from misplaced sutures (which were placed by a resident supervised by a fellow--don't let anyone but your surgeon touch your eye!)  It takes several months for vision to fully recover, although there should be major improvement after a few weeks.  I can currently read the 20/20 line on an eye chart with my affected eye, but I still have some mild distortion (which is not apparent using both eyes).  
233488 tn?1310696703
MEDICAL PROFESSIONAL
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