Schwartz–Matsuo syndrome is sudden or fluctuating high eye pressure that happens at the same time as a rhegmatogenous retinal detachment. In SMS, the drainage filter of the eye (the trabecular meshwork) is clogged by tiny fragments from the retina’s light-sensing cells (photoreceptor outer segments) that have leaked forward through the retinal tear into the eye’s fluid. Because the filter is blocked, fluid cannot leave the eye easily, and pressure rises—sometimes to very high levels. When the retina is reattached, those fragments stop coming forward, the filter clears, and the pressure usually returns to normal. This explains why treating the detachment is the main cure for SMS, while pressure-lowering drops are supportive and temporary. EyeWikiNCBIBioMed Central

Scleral buckling is a retina-reattaching operation used for RRD. The surgeon places a soft silicone band or sponge on the outside white wall of the eye (the sclera). The band gently indents the wall so it pushes the eye wall closer to the retinal tear, takes tension off the retina, and closes the break from the outside. The tear is then sealed with freezing (cryopexy) or laser, and the retina reattaches as fluid is pumped away by the retinal pigment epithelium. Buckling has been used for over 60 years and is still chosen as a primary or adjunct procedure depending on the detachment pattern, lens status, and surgeon preference. EyeWikiNCBIPubMed

Rhegmatogenous retinal detachment happens when a small break, hole, or tear opens in the retina. Fluid from the middle of the eye (the vitreous) then slips through that opening and collects under the retina. This pocket of fluid gently lifts the retina off the inside wall of the eye, the way a small bubble can lift wallpaper off a wall. When the retina lifts, it cannot work well, and vision becomes blurry, shadowed, or missing in the area that has lifted. This is an urgent problem because the light-sensing cells in the retina need to sit flat against the wall of the eye to stay healthy.

Scleral buckling is an operation designed to fix this problem from the outside of the eye. The surgeon sews a soft silicone piece (called a buckle) onto the white outer coat of the eye (the sclera). The buckle gently presses the wall of the eye inward by a small amount. That inward press brings the wall of the eye closer to the torn retina and changes the internal pulling forces from the vitreous gel. In simple terms, the buckle closes the leak at the retinal break, reduces traction (tugging) on the tear, and supports the retina while the surgeon creates a permanent seal around the tear with a freezing treatment (cryotherapy) or occasionally laser. Once the tear is sealed and the fluid under the retina is absorbed (naturally or with careful drainage during surgery), the retina can lie flat again and vision has a chance to recover.

Scleral buckling is time-tested. It is especially helpful in eyes that still have their natural lens (phakic eyes), in younger patients, and when the retinal breaks are located toward the front edge of the retina. It can be used alone or together with other techniques, such as vitrectomy or temporary gas inside the eye, depending on the pattern of the detachment.

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How scleral buckling works (mechanism)

• Closes the leak: The buckle indents the eye wall under the retinal tear so the edges of the tear meet the underlying tissue again. Imagine placing a finger gently under a small hole in a balloon to stop air from escaping—the hole collapses.

• Relieves traction: The buckle changes the shape of the eye wall and the angle of the vitreous gel’s pull on the retina. This reduces tugging on the tear so it can stay closed.

• Creates a scar seal: The surgeon freezes around the tear (cryotherapy). This controlled freezing causes a small, sticky scar that forms over days to weeks, sealing the edges of the break to the wall of the eye. Laser can also be used in some settings.

• Lets fluid leave: Once the break is closed and the tugging is reduced, the trapped fluid under the retina can be re-absorbed by the eye’s natural pumps. Sometimes the surgeon drains a small amount of this fluid during surgery to help the retina flatten faster.

Doctors think about scleral buckling when the detachment is caused by one or more retinal breaks, especially if the breaks are toward the front of the retina, if the patient is younger or still has the natural lens, if there is a dialysis (a tear near the edge of the retina from trauma), or if there are specific patterns like lattice degeneration with small holes. In many other cases—such as complex detachments, significant scar tissue on the retina (proliferative vitreoretinopathy), or in eyes after cataract surgery—doctors may combine a buckle with vitrectomy or use vitrectomy alone. The choice is individualized.

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Types of scleral buckling

1. Segmental buckle: A short piece of silicone is sewn only under the area of the tear. It supports just the problematic sector. This is like placing a small wedge under a loose shingle to hold it down exactly where it lifted.

2. Radial buckle: A short element is placed pointing from the back of the eye toward the front (like a spoke on a wheel) under a tear that runs outward from the center. This can be very effective for “horseshoe” tears.

3. Circumferential (encircling) band: A silicone band goes all the way around the eye like a belt. It gently tightens to change overall vitreous traction and supports multiple or uncertain break locations. It is often used when there are several small breaks or when the exact break is hard to find.

4. Combined segmental + encircling: A 360° band is placed for general support and a small segment is added under the main tear for extra indentation. This gives both global and local support.

5. Solid silicone tire vs. silicone sponge: Some buckles are firm (solid tires) and create a well-defined indentation. Others are spongy and compress more softly. Surgeons choose based on the tear pattern and their experience.

6. With external drainage vs. without drainage: Sometimes the surgeon makes a tiny, controlled opening through the sclera to drain a little subretinal fluid during surgery. This can help the retina lie flat immediately. In other cases, no drainage is needed because the fluid will absorb on its own after the tear is sealed.

7. Cryotherapy vs. laser retinopexy: Most buckling surgeries use cryotherapy from the outside, which works well with the buckle. In selected cases, laser may be used if the view is clear and the break is accessible.

8. Temporary gas adjunct: A small bubble of gas may be injected into the eye to gently press the retina from the inside while the buckle supports from the outside. The gas is temporary and the body absorbs it over days to weeks.

9. Primary buckle vs. buckle combined with vitrectomy: In simpler, front-located breaks in phakic eyes, a primary buckle alone can be chosen. In more complex or posterior breaks, a combined approach may be used.

10. Low-profile vs. higher-profile buckle height: The amount of indentation is adjusted to balance support and comfort. The surgeon chooses the height to close the break without over-tightening the eye.

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Causes

1. Age-related posterior vitreous detachment (PVD): With age, the vitreous gel liquefies and peels away from the retina. This peeling can tug and create a tear. A tear allows fluid to slip under the retina and start a detachment.

2. Lattice degeneration: Thinned, lattice-like patches near the edge of the retina are weaker and more prone to tiny holes or tears, especially when the vitreous pulls.

3. High myopia (long, nearsighted eyes): A longer eyeball stretches and thins the retina and peripheral tissues, making tears and detachments more likely and often at a younger age.

4. Blunt eye trauma: A hard hit can cause a “retinal dialysis,” which is a tear where the retina meets the front edge (ora serrata). This is common in sports or accidents.

5. Penetrating eye injury: Cuts or punctures to the eye can directly tear the retina or set the stage for later traction and tearing.

6. Cataract surgery (pseudophakia): Most patients do well, but any intraocular surgery can slightly increase the chance of later retinal tears and detachment, especially if complications occurred.

7. Aphakia (no lens present): Eyes without a lens are at higher risk because the internal support for the vitreous is reduced, and the vitreous can pull more on the retina.

8. Giant retinal tears: Very large horseshoe-shaped tears can develop in certain eyes and can quickly lead to detachment. These often require strong support, sometimes a buckle plus vitrectomy.

9. Stickler syndrome (hereditary vitreoretinopathy): This genetic condition weakens the vitreous and retina, causing early tears and detachments, often in young patients.

10. Marfan syndrome: Connective tissue changes in Marfan syndrome can alter the structure of the eye and vitreous, increasing tear risk.

11. Ehlers–Danlos syndrome: Fragile connective tissues can make the retina and vitreous interface more vulnerable to traction and tearing.

12. Family history of RRD: If close relatives have had detachment, personal risk is higher, likely due to shared anatomy or genetics.

13. Detachment in the fellow eye: A history of RRD in one eye increases the chance of detachment in the other eye, so symptoms there should be watched closely.

14. Atrophic round holes in lattice areas: Tiny round holes may form without a big tug. Fluid can slowly leak through and lift the retina over time.

15. Operculated tears from acute PVD: When a small piece of retina is pulled free (the “operculum”), a full-thickness tear remains behind and can leak fluid.

16. Retinal dialysis after unnoticed minor trauma: Even smaller injuries can later lead to a tear at the ora serrata that slowly progresses.

17. Degenerative retinoschisis with outer-layer breaks: In rare cases the outer layer also breaks, allowing fluid to pass and creating a true rhegmatogenous detachment.

18. Necrotizing viral retinitis (e.g., acute retinal necrosis): Inflammation and tissue death thin the retina, making it prone to tears and detachment.

19. Posterior capsule rupture or vitreous loss during surgery: Complicated cataract surgery events can change vitreous traction patterns and raise tear risk later.

20. Vitreoretinal tufts and meridional folds: Small abnormal attachments or folds near the periphery can act as anchors for traction and serve as starting points for tears.

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Symptoms

1. New floaters: You may see new small spots, strands, or cobwebs drifting in your vision because cells or tiny clumps enter the vitreous when a tear forms.

2. Flashes of light (photopsia): You may see brief, bright flashes at the edge of your vision, especially in the dark, because the tugging vitreous stimulates the retina.

3. A curtain or shadow: You may notice a dark curtain or veil coming from the side, top, or bottom, which is the area of retina that has lifted and no longer sends a normal picture.

4. Peripheral vision loss: Side vision can fade first, because detachments often start in the far edge of the retina and creep inward.

5. Blurred or dim vision: As more retina lifts, the picture becomes faint or foggy, and fine detail is lost.

6. Wavy or bent lines (metamorphopsia): Straight lines may look bent or warped if fluid collects under the retina and changes its smooth contour.

7. Central vision drop (if the macula detaches): When the center of the retina lifts, reading and face recognition become very difficult, and letters may disappear.

8. Gray or smoky patch that does not move: A part of the scene may look washed out or gray all the time, matching the area of detached retina.

9. Reduced color brightness: Colors can look dull or less vibrant because fewer healthy retinal cells are capturing light.

10. Trouble reading small print: Fine detail becomes hard to see as the retinal image blurs and contrast falls.

11. Poor night vision: Dim light tasks become harder if the peripheral retina, which helps in low light, is not attached.

12. Many tiny black dots (“soot-shower” floaters): Pigment cells released from a fresh tear can look like a shower of tiny specks.

13. No pain despite vision changes: The eye usually does not hurt, which can be misleading; the lack of pain does not mean the problem is minor.

14. Symptoms worse with eye or head movement: Movement can transiently increase traction, so flashes or floaters may seem more obvious when you move.

15. Sudden onset: Many people notice that the change happened quickly, over hours to a day or two, which is a warning sign to seek care urgently.

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Diagnostic tests

A) Physical exam

1. Visual acuity (distance and near): Reading letters on a chart measures how clearly each eye sees. A drop helps quantify the impact and guides urgency.

2. Pupil exam with RAPD check: The doctor shines lights to see how pupils react. A relative afferent pupillary defect can appear in large or long-standing detachments.

3. Confrontation visual fields: The doctor checks side vision by comparing it to theirs. Missing areas can match the detachment’s location.

4. Intraocular pressure (tonometry): Pressure is often slightly lower in an eye with a fresh rhegmatogenous detachment, which is a useful clue.

5. Dilated fundus exam with binocular indirect ophthalmoscopy: After dilating drops, the doctor looks carefully at the entire retina with a bright light and lens, searching for all tears, holes, and the full edge of the detachment.

B) Manual tests

6. Pinhole test: Looking through a small pinhole can bypass some focusing errors. If the vision fails to improve through the pinhole, it suggests a retinal rather than a refractive problem.

7. Amsler grid: A small square grid is viewed at reading distance. Wavy or missing boxes can indicate macular involvement.

8. Photostress recovery test: Staring at a bright light briefly then timing recovery helps judge macular function; slow recovery can reflect macular detachment.

9. Scleral depression during indirect exam: The examiner gently presses on the outer eye with a smooth depressor while viewing the retina. This manual maneuver helps reveal small or hidden tears near the edge.

C) Lab and pathological tests

10. Complete blood count (CBC): Checks general health and readiness for surgery and can reveal anemia or infection that might affect healing or anesthesia planning.

11. Blood glucose or HbA1c: Identifies diabetes control status, which influences healing and the chance of other retinal problems.

12. Coagulation profile (PT/INR, aPTT): Important if drainage of subretinal fluid is planned or if the patient uses blood thinners; it helps minimize bleeding risks.

13. Sickle cell screening or hemoglobin electrophoresis (when indicated): In at-risk groups, this can affect bleeding risk and surgical decisions because sickling changes blood flow in the eye.

D) Electrodiagnostic tests

14. Full-field electroretinography (ERG): Measures the electrical response of the retina to light. It helps estimate overall retinal health, especially in chronic or complicated cases.

15. Visual evoked potential (VEP): Measures signals traveling from the eye to the brain. It can help separate retinal from optic nerve causes of poor vision when the picture is unclear.

16. Electro-oculography (EOG): Assesses the function of the retinal pigment epithelium (RPE), which is important for retinal adhesion and fluid pumping.

E) Imaging tests

17. B-scan ultrasonography: Sound waves create a picture of the back of the eye when the view is blocked by blood or a dense cataract, confirming the detachment and showing its extent.

18. Optical coherence tomography (OCT): This painless scan provides cross-section images of the macula and nearby retina, showing if the center is attached or lifted and helping with timing.

19. Ultra-widefield fundus photography: A large, color photo map documents the retina and can capture the detachment edge and breaks for planning and follow-up.

20. Fundus autofluorescence (FAF): Highlights metabolic patterns in the RPE layer; in detachments, it can outline the lifted retina and help assess chronic changes.

Non-pharmacological treatments (therapies & others)

Each item includes: what it is, purpose, and how it helps (mechanism). These measures are used before, during, or after surgery. Some are supportive; some are procedures that don’t involve taking a drug.

1. Urgent ophthalmology referral and activity modification.
   Purpose: get you to surgery quickly and reduce risk of the central retina (macula) detaching.
   Mechanism: prompt triage; avoiding jarring movements reduces dynamic fluid shifts that could extend the detachment. AAO-HNS

2. Protective eye shield and “no eye-rubbing.”
   Purpose: prevent accidental pressure or trauma.
   Mechanism: avoids extra traction on the torn retina.

3. Head positioning before surgery (macula-sparing posture).
   Purpose: keep the macula attached as long as possible when only the peripheral retina is off.
   Mechanism: gravity positioning reduces fluid sliding under the macula. AAO-HNS

4. Education about warning symptoms (flashes, sudden floaters, curtain/shadow, pain from high pressure).
   Purpose: speed up care-seeking; prevents delay.
   Mechanism: earlier detection → earlier repair → better visual outcomes. AAO-HNS

5. Scleral buckling (external retinal support).
   Purpose: close the retinal break and reattach the retina (definitive cure for the cause of SMS).
   Mechanism: external indentation relieves vitreoretinal traction; cryo/laser seals the break. EyeWiki

6. Laser retinopexy (around the tear).
   Purpose: weld the retina to the eye wall around and/or after reattachment.
   Mechanism: laser burns create a strong scar barrier to stop fluid passing through the break. AAO-HNS

7. Cryotherapy (freezing the tear).
   Purpose: alternative or adjunct to laser to seal the break, especially when media are hazy.
   Mechanism: cold-induced chorioretinal adhesion forms a seal. EyeWiki

8. Pars plana vitrectomy (PPV).
   Purpose: internal approach to remove vitreous traction, peel membranes, and treat multiple or posterior breaks.
   Mechanism: removes pulling forces; allows internal laser and gas/oil tamponade. (Used instead of or with buckle.) PubMed+1

9. Pneumatic retinopexy (PR).
   Purpose: minimally invasive option for selected superior breaks.
   Mechanism: intravitreal gas bubble presses the retina against the RPE while laser/cryo seals the tear. PubMed

10. Subretinal fluid drainage (during buckle).
    Purpose: flatten the retina immediately if fluid is tense.
    Mechanism: controlled external drainage reduces height of detachment and aids break closure. NCBI

11. Choice of segmental vs encircling buckle.
    Purpose: tailor support to one tear (segmental) or diffuse pathology (encircling).
    Mechanism: biomechanical indentation under the area of traction vs 360° support. EyeWiki

12. Gas tamponade after vitrectomy (SF6/ C3F8).
    Purpose: hold retina in place while adhesions mature.
    Mechanism: long-acting bubble provides internal pressure; patient positions as instructed. PubMed

13. Silicone oil tamponade (complex cases).
    Purpose: long-term internal support for proliferative vitreoretinopathy (PVR) or travel altitude needs.
    Mechanism: buoyant, stable internal fill that holds retina attached until membranes are controlled. PubMed

14. Strict post-operative positioning.
    Purpose: keep the bubble or buckle optimally aligned with the break.
    Mechanism: gravity and contact pressure maintain closure; improves anatomic success. PubMed

15. Stop contact sports / heavy lifting until surgeon clears.
    Purpose: avoid vitreous traction and pressure spikes.
    Mechanism: reduces sudden acceleration forces across the retina.

16. Avoid driving and hazardous work until vision stabilizes.
    Purpose: safety and fall-risk reduction.
    Mechanism: prevents injury during recovery.

17. IOP monitoring schedule (early and frequent).
    Purpose: detect fast changes in pressure typical of SMS and post-op periods.
    Mechanism: timely adjustment of drops, tablets, or fluid management. EyeWiki

18. Counseling about air travel and altitude after gas.
    Purpose: prevent dangerous IOP spikes from expanding gas.
    Mechanism: Boyle’s law—gas expands as cabin pressure falls.

19. Smoking cessation support.
    Purpose: better microvascular health and wound healing.
    Mechanism: improves oxygen delivery and reduces inflammation.

20. Vision rehabilitation planning if recovery is partial.
    Purpose: maximize function (magnifiers, lighting, contrast).
    Mechanism: compensates for permanent photoreceptor loss in some cases.

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Evidence-based drug treatments

(Use only under an eye doctor’s supervision. Typical adult doses shown; individualized plans may differ. “Timing” = when we use it in SMS/RRD care.)

1. Timolol 0.25–0.5% eye drops (class: β-blocker)
   Dose: 1 drop BID. Timing: while awaiting surgery and early post-op if pressure is high.
   Purpose: quickly lower IOP. Mechanism: reduces aqueous humor production.
   Side effects: slow heart rate, low blood pressure, bronchospasm in asthma/COPD; fatigue.

2. Brimonidine 0.1–0.2% eye drops (class: α2-agonist)
   Dose: 1 drop TID (sometimes BID). Timing: add-on for further pressure control.
   Mechanism: lowers aqueous production and increases uveoscleral outflow.
   Side effects: dry mouth, fatigue, allergy/redness; caution in infants.

3. Dorzolamide 2% or Brinzolamide 1% drops (class: topical carbonic anhydrase inhibitor)
   Dose: 1 drop TID (often BID in combo). Timing: adjunct to timolol.
   Mechanism: decreases aqueous production by blocking carbonic anhydrase in ciliary body.
   Side effects: bitter taste, stinging; rare sulfonamide-type reactions.

4. Dorzolamide–Timolol fixed combo
   Dose: 1 drop BID. Timing: simplifies multi-drug regimens; good for rapid pressure control.
   Mechanism: dual aqueous suppression.
   Side effects: those of each component.

5. Acetazolamide tablets (class: systemic carbonic anhydrase inhibitor)
   Dose: 250 mg 3–4×/day or 500 mg ER BID. Timing: short-term bridge before surgery or early post-op.
   Mechanism: strong reduction of aqueous production.
   Side effects: tingling, frequent urination, fatigue, GI upset; rare kidney stones, metabolic acidosis; avoid in sulfa allergy.

6. Mannitol IV (class: hyperosmotic agent)
   Dose: 0.5–1 g/kg IV over 30–60 min. Timing: severe, vision-threatening IOP spikes not controlled by drops/tablets.
   Mechanism: draws fluid out of the eye by osmotic gradient.
   Side effects: dehydration, electrolyte shifts, heart strain; hospital/monitored use only.

7. Latanoprost 0.005% (class: prostaglandin analog)
   Dose: 1 drop QHS (nightly). Timing: add if pressure remains above target.
   Mechanism: increases uveoscleral outflow.
   Side effects: redness, eyelash growth, iris/skin darkening; rare macular edema in susceptible eyes.

8. Netarsudil 0.02% (class: Rho-kinase inhibitor)
   Dose: 1 drop QHS. Timing: add-on when other agents insufficient.
   Mechanism: improves trabecular outflow by relaxing the meshwork and lowering episcleral venous pressure.
   Side effects: conjunctival hyperemia, corneal verticillata.

9. Cycloplegic (e.g., Atropine 1% drops)
   Dose: 1 drop BID–TID short term. Timing: for comfort and to stabilize the lens–iris diaphragm when painful ciliary spasm occurs around detachment or after surgery.
   Mechanism: relaxes the ciliary muscle, reduces pain, and can decrease inflammation-related posterior synechiae.
   Side effects: light sensitivity, blurry near vision; keep away from children’s hands.

10. Topical corticosteroid (e.g., Prednisolone acetate 1%)—selectively and briefly
    Dose: QID then taper if significant inflammation is present after repair.
    Mechanism: calms post-operative inflammation; does not treat SMS itself and can raise IOP—use only when indicated and monitored.
    Side effects: steroid response (IOP rise), delayed healing, infection risk.

Why these drugs? SMS pressure typically responds well to aqueous suppression (β-blockers, α2-agonists, CAIs; sometimes prostaglandin or ROCK inhibitors). The definitive fix remains reattachment surgery. EyeWikiBioMed Central

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Dietary molecular supplements

(Support eye health in general; not a cure for detachment or SMS. Discuss with your doctor—some interact with blood thinners, diabetes meds, or surgery plans.)

1. Omega-3 (EPA/DHA) 1–2 g/day.
   Supports retinal cell membranes; anti-inflammatory lipid mediators may aid recovery.

2. Lutein 10 mg + Zeaxanthin 2 mg/day.
   Macular pigments that filter blue light and support photoreceptor metabolism.

3. Vitamin C 500 mg/day.
   Antioxidant support for collagen and wound healing.

4. Vitamin E 200 IU/day.
   Lipid antioxidant for photoreceptor outer segments (avoid very high doses).

5. Zinc 25–40 mg elemental/day (short course).
   Cofactor for many retinal enzymes; avoid long-term high dosing.

6. Taurine 500–1000 mg/day.
   Amino-sulfonic acid abundant in retina; supports photoreceptor function.

7. Coenzyme Q10 100–200 mg/day.
   Mitochondrial cofactor; may help oxidative stress handling.

8. Curcumin 500–1000 mg/day with piperine.
   Anti-inflammatory signaling modulation.

9. Resveratrol 150–300 mg/day.
   Sirtuin pathway activation; antioxidant effects.

10. Bilberry anthocyanins 80–160 mg/day.
    Vascular support and antioxidant activity.

Evidence note: these are adjunctive wellness supports. None of them reattach a retina or directly “treat” SMS; surgery and proper medical therapy do that. (Professional bodies emphasize urgent surgical repair for RRD.) AAO-HNS

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Regenerative / stem-cell” items

There are no approved “immunity-booster drugs” or stem-cell drugs for SMS or routine RRD. Some adjuvants are under study for complicated detachments with PVR. Dosing varies by trial; not for self-use.

1. Intravitreal methotrexate (investigational for PVR).
   Function/mechanism: low-dose anti-proliferative to reduce membrane recurrence. Dose: protocol-specific micro-doses only in theatre/clinic. Status: off-label/clinical trial.

2. 5-Fluorouracil + low-molecular-weight heparin infusion during PPV (investigational).
   Mechanism: reduces fibrocellular proliferation on the retinal surface. Status: selected centers, protocolized use.

3. Intravitreal corticosteroid (e.g., triamcinolone) as adjuvant (selected cases).
   Mechanism: suppresses inflammation that contributes to scarring; risk of IOP rise—careful selection.

4. Rho-kinase–pathway modulation for retinal repair (preclinical/early clinical).
   Mechanism: cytoskeletal effects that may influence scarring and blood flow; not standard of care.

5. Retinal progenitor or RPE stem-cell transplantation (research only).
   Mechanism: aims to replace/support damaged photoreceptors/RPE after severe disease. Status: experimental; no approved dose.

6. MSC-derived exosomes / gene-therapy approaches for unrelated inherited retinal disease—not for SMS.
   Mechanism: cell-signaling or genetic correction; not treatment for SMS/RRD; included here for completeness.
   Bottom line: these are not routine treatments for SMS or uncomplicated RRD; discuss only within a clinical trial context. PubMed

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Surgeries

1. Scleral buckling (segmental or encircling).
   Procedure: silicone band/sponge sutured to sclera; cryo/laser seals tear; optional external drainage of subretinal fluid.
   Why it’s done: definitive closure of the break from outside; especially useful in younger, phakic patients with peripheral breaks. EyeWikiNCBI

2. Pars plana vitrectomy (PPV).
   Procedure: tiny ports in the eye; vitreous gel removed; internal laser; gas or oil placed.
   Why: removes traction, treats posterior or multiple breaks, handles PVR. Comparative trials/meta-analyses guide selection versus buckle. PubMed+1

3. Pneumatic retinopexy (PR).
   Procedure: gas bubble injection + office laser/cryo with strict head positioning.
   Why: minimally invasive option for selected superior tears; quick recovery in the right pattern. PubMed

4. Laser retinopexy / cryopexy (adjunct).
   Procedure: laser burns or cold probe around tear.
   Why: creates permanent adhesion to stop fluid re-entry. AAO-HNS

5. Buckle revision or removal (rare).
   Procedure: adjust or remove silicone if infection, exposure, or diplopia occurs.
   Why: treat buckle-related complications and restore comfort/ocular mechanics. Ophthalmology Retina

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Preventions

1. Know the symptoms: new flashes, showers of floaters, a gray curtain, sudden blurred or side-vision loss. Act fast. AAO-HNS

2. Routine dilated exams if you are highly myopic, have lattice degeneration, or a family history. AAO-HNS

3. Protective eyewear during sports, yard work, and construction.

4. Prompt care for new floaters after trauma—don’t wait it out. AAO-HNS

5. Glycemic and blood-pressure control for overall ocular health.

6. Avoid unnecessary eye rubbing (creates micro-trauma and pressure spikes).

7. Discuss risky drops (e.g., strong miotics) with your ophthalmologist if you have a history of tears/detachment risk.

8. Follow post-op instructions precisely after any retinal repair.

9. Don’t fly or ascend to altitude with an untreated gas bubble in the eye.

10. Stop smoking; support healthy healing and microcirculation.

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When to see a doctor (red-flag list)

• Right now if you notice new flashes, many new floaters, a curtain/shadow, or eye pain with nausea (very high pressure).

• Right now if vision in the affected eye drops suddenly or the other eye develops any of the above.

• Urgently after head/eye trauma with visual symptoms.

• Promptly if you are post-op and develop severe pain, a sudden increase in floaters, light sensitivity, or discharge.

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Things to eat (and to avoid)

Eat more of:

1. Fatty fish (sardine, salmon) for omega-3s.

2. Dark leafy greens (spinach, kale) for lutein/zeaxanthin.

3. Citrus and berries for vitamin C.

4. Nuts/seeds for vitamin E and minerals.

5. Colorful vegetables (peppers, carrots, pumpkin) for carotenoids.

6. Legumes for plant protein and zinc.

7. Eggs (yolk contains lutein/zeaxanthin).

8. Hydrating fluids (water first).

9. Whole grains for steady glucose control.

10. Spices like turmeric (with pepper) added to meals.

Limit/avoid:

1. Smoking and second-hand smoke (vision-toxic).

2. Heavy alcohol (impairs healing).

3. Ultra-processed foods high in trans fats.

4. Very high-salt snacks if you’re fluid-sensitive.

5. Excess added sugars (glycemic spikes).

6. Mega-dosing fat-soluble vitamins without guidance.

7. Herbal blood thinners (ginkgo, high-dose garlic) right before surgery.

8. Energy drinks that raise blood pressure/heart rate.

9. Dehydration (thickens blood, headache).

10. Crash diets during recovery.

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FAQs

1. Does SMS mean I have glaucoma forever?
   No. SMS is a temporary, secondary high-pressure state linked to RRD. Pressure usually normalizes after the retina is reattached. Ongoing glaucoma is uncommon but IOP must be monitored. EyeWikiBioMed Central

2. Why is my pressure so high if most detachments have low pressure?
   In typical RRD the pressure can be low, but in SMS photoreceptor fragments clog the drain, so pressure spikes instead. EyeWiki

3. What fixes SMS: drops or surgery?
   Drops and tablets buy time and protect the optic nerve, but reattaching the retina is the definitive fix. BioMed Central

4. Is scleral buckle still used in the “vitrectomy era”?
   Yes. Buckling remains important, especially in younger phakic eyes with peripheral breaks, and is sometimes combined with vitrectomy. Choice depends on break location, lens status, and surgeon judgment. PubMed

5. What are the main risks of a buckle?
   Infection or exposure of the band, double vision, myopic shift, bleeding, choroidal detachment—most are uncommon and treatable. EyeWiki

6. How soon will pressure fall after repair?
   Often quickly, as the debris source stops and the trabecular meshwork clears. You may still need short-term drops. BioMed Central

7. Can I fly after surgery?
   Not if a gas bubble is in your eye; gas expands and can dangerously raise pressure. Your surgeon will tell you when it’s safe.

8. Is laser alone enough?
   Laser seals breaks but usually needs buckle, PR, or PPV to position the retina while the adhesions mature. AAO-HNS

9. Which is better: buckle, PR, or PPV?
   It depends on tear pattern and patient factors; randomized and systematic studies guide selection, and surgeons often customize. PubMed+1

10. Will I need the buckle removed later?
    Rarely. Removal/revision is done for exposure, infection, or persistent double vision. Ophthalmology Retina

11. Do steroids treat SMS?
    No. SMS is not primarily inflammatory and doesn’t respond to steroids as a pressure-lowering therapy (steroids can even raise IOP). They are used only for specific post-op inflammation. EyeWiki

12. Are there real “immunity booster” drugs for this?
    No. Immune-modulating or regenerative therapies are research-only for special complications like PVR; they are not standard SMS care. PubMed

13. How fast should I seek care for new flashes/floaters?
    Immediately—same day if possible. Early repair protects vision. AAO-HNS

14. Can SMS happen again?
    It can recur if the other eye or the same eye develops a new detachment. Prevent by rapid reporting of symptoms and regular checks. AAO-HNS

15. What’s the long-term outlook?
    With timely repair, many eyes reattach and pressure normalizes. Visual outcome depends on whether the macula detached and for how long. PubMed

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 24, 2025.

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