Complications of silicone oil in vitreoretinal surgery: a narrative review of clinical and experimental evidence.

Our purpose was to review the existing literature on the clinical and immunopathologic adverse effects of silicone oil (SO). A review was performed of studies published from 1993 to October 2025 in PubMed/MEDLINE, Web of Science, ClinicalTrials.gov, and Cochrane Library. Heavy SO agents were excluded. For silicone oil-related visual loss (SORVL), only rhegmatogenous retinal detachment studies reporting macular status were included. The review is organized into subthemes, including SORVL, emulsification, SO-related corneal and lens changes, retinal layer abnormalities, vascular changes, glaucoma, electrolyte balance, globe deposits, and optic neuropathy. Currently, there is no consensus explanation for SORVL, either due to the different surgical methodologies, the complexity of cases, or the lack of routine multimodal testing. SORVL was frequently associated with inner macular thinning, papillomacular bundle damage, and reduced macular vessel density. Emulsification and globe deposits have been described as a possible cause for the irreversible nature of some adverse effects. Longer SO duration was frequently, but not always, related to structural ocular changes. Finally, cytokine and electrolyte profiles provide evidence of inflammatory and potentially toxic mechanisms. In this review, we compiled the most recent evidence on the structural and functional complications associated with SO (such as macular thinning, SORVL, and optic neuropathy). We then summarized the pathophysiological mechanisms that may lead to these complications, including inflammation, phototoxicity, emulsification, and globe deposits. Standardized definitions (particularly for SORVL and SO-related ocular hypertension), multimodal monitoring protocols, and consensus on safe tamponade duration are still lacking.