Positioning after retinal surgery: a practical guide

What does recovery look like at a glance?

The number of days that you need to position depends on your condition. It is usually between 1 to 5 days and Dr Chen will advise you how many days are needed. Someone else's instructions may be different because their operation, retinal problem or bubble is different. The broader vitrectomy recovery guide explains the rest of the recovery timetable.

What is normal in the first day or two?

Getting used to a new position can be awkward. Adjusting the height of a chair, table or face support often makes a substantial practical difference.

Some mild muscular stiffness may occur, but persistent neck or back pain, numbness, tingling or difficulty breathing needs attention. Tell the team about arthritis, neck problems, breathing conditions, limited mobility or previous difficulty lying prone before surgery whenever possible. The plan can then account for what you can realistically manage.

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Why does the direction of my head matter?

The retina is the light-sensitive lining at the back of the eye. During vitrectomy surgery, a gas bubble may be placed inside the eye to support a macular hole or an area of retinal detachment while it heals. Gas floats upwards. Changing the direction of your head changes which part of the retina the bubble supports.

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Face-down positioning means pointing your nose towards the floor, with your face roughly parallel to it. Looking down with your eyes while keeping your head upright does not have the same effect. For side positioning, the instruction should identify the cheek that rests on the pillow, so there is no ambiguity about “left” or “right”.

Not every retinal operation requires face-down positioning, and not every vitrectomy uses gas. Silicone oil may also require a particular position; follow the instructions for the material and repair used in your eye. Do not assume that advice for another patient's operation applies to yours.

How should I organise the 50-minute routine?

Use a timer for 50 minutes on and 10 minutes off each hour during the day. For example, position from 9:00 to 9:50, take your break until 10:00, then begin again.

Use breaks for the toilet, eye drops, a drink, food and gentle movement.

Try to organise help around the routine. A family member can bring a meal or remind you about drops without interrupting each positioning period.

How can I position face down without special equipment?

You do not necessarily need to hire equipment. A stable table and chair, ordinary pillows and clean rolled towels may be enough to support the prescribed position.

At a table: sit on a steady chair with your feet supported. Arrange two ordinary pillows with a gap for your face, or use a boomerang pillow. Rest your forehead on the support, keeping your eyes free of pressure and your nose and mouth clear. Adjust the height so your shoulders stay relaxed and your face points towards the floor. Keep your back and neck comfortably aligned. Rest your hands in your lap or your arms by your sides, with elbows no higher than your shoulders. Avoid holding your arms high around your head, which can make your neck and shoulders stiff.

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Why avoid raised arms? Holding your arms up around your head can make your neck and shoulders stiff. Lower your arms and let the pillows or towels support your forehead. Keep your eyes free of pressure, your breathing space open and your head in the prescribed direction.

Using towels: rolled bath towels are an alternative. Use clean, soft towels to provide a padded forehead support. A towel curved around the face must leave ample room for the eyes, nose and mouth, with an open route for air to enter and leave. A hole in the middle is not enough if it is sealed underneath by a table or mattress. Do not let the towel press on either eye or push your chin towards your chest. Check that it stays in place as it compresses under your weight.

On a bed: ordinary pillows can support your chest and body while a separate head support leaves your face clear. Do not bury your face in bedding. Practise the arrangement while awake and use the sleeping position written in your plan. Alternating suitable sitting and lying setups can reduce pressure on the same muscles.

Sitting with ordinary household supports

Choose a setup that maintains the head direction in your plan. Adjust the support height to your body. The pictures show different arrangements; the required head direction remains the same.

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Lying with ordinary pillows or towels

These show different ways of arranging support while lying on the front. Do not assume an example is your prescribed sleeping position.

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How can I sit face down more comfortably?

Use a stable chair, a comfortable support height, supported feet, relaxed shoulders and padded forearms. Leaning forward from the hips is often easier than bending only your neck. Keep the face directed down in the way the team demonstrated.

A purpose-designed tabletop face support or positioning chair may help. Check that it fits your height and lets you breathe freely. Do not press the operated eye against a cushion, and do not use a support that makes breathing difficult. The opening should leave the nose and mouth unobstructed.

Change between approved sitting and lying arrangements if your plan permits. This can distribute pressure and reduce stiffness. Avoid spending long periods leaning on your elbows: sustained pressure can irritate nerves and cause tingling or numbness in the hands.

What if I cannot lie face down?

For a macular hole, if asked to position face down but you cannot manage it, the next-best position is to lie with the opposite cheek to the operated eye on the pillow:

• Right eye operated: left cheek on the pillow.
• Left eye operated: right cheek on the pillow.

This is a fallback when the prescribed face-down position is not manageable. It is not the first choice for everyone.

For a retinal detachment, the second-choice position depends on where the retina was repaired. It must be written in your plan. Do not use the macular-hole opposite-cheek rule for a retinal detachment. If the fallback is missing or you cannot manage either position, contact the surgical team rather than guessing.

What do the cheek and upright positions look like?

Use only the position named in your plan. Sitting with a cheek on a pillow, lying on the front with the head turned, and lying on the side are different arrangements. Left and right refer to your own cheek, not the viewer’s left and right. Upright positioning is a separate instruction, not a substitute for prescribed face-down positioning.

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How should I sleep?

Use the separate sleeping instruction in your plan. It may differ from your daytime position.

For face-down sleep, an open face support can provide breathing space. Adjust it to the bed and your body, and practise getting in and out safely. Never bury your face in an ordinary pillow. For prescribed side sleep, support your head so it stays comfortably aligned with your body; a pillow between the knees may improve comfort.

Avoid lying flat on your back while gas remains unless your surgeon specifically advises otherwise. If you wake in the wrong position, return to the prescribed one.

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Can a backpack help stop me rolling onto my back?

If side sleeping is prescribed, a pillow behind your back may help you remain on your side. Another practical option is a small, soft backpack loosely filled with light towels, worn on your back to discourage rolling onto it. A towel-filled backpack can be used as a posturing aid.

Keep it light and comfortable. Do not put hard or heavy objects inside, tighten straps across your chest, or use ties or restraints. You must be able to breathe normally, change position safely and get out of bed.

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What else makes positioning easier at home?

Prepare the room before surgery if possible. Keep pathways clear, use good lighting and put your phone, water and other essentials within easy reach. Arrange help with shopping, cooking, transport and other responsibilities so you can concentrate on recovery.

Audio books, podcasts, music and conversation can make long periods less isolating. A positioning mirror may let you see the room or television while keeping your head down. Reading or using a device is only useful if the setup lets you maintain the prescribed position comfortably; do not lift your head repeatedly to see a screen.

Wear loose, comfortable clothing and check for pressure from seams or straps. Use the scheduled breaks to move gently, eat and drink, within your discharge instructions. Take care when walking because vision and judging distances may be affected after surgery. Rise slowly from the chair or bed: some people feel faint or unsteady after a long positioning session. Pause before walking, and have someone help if needed.

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Do I need to buy or hire equipment?

Many people can use ordinary pillows or rolled towels with a stable table and chair, as described above. Others find a specialist face-down chair or bed support more comfortable. Equipment is useful only if it achieves your prescribed position, keeps pressure off the eye and remains comfortable and safe. Ask the team to assess your setup rather than assuming a product photograph shows the right position for you.

In Sydney, Summit Support → offers hire equipment. Contact them before surgery on 1300 133 116 to check suitability, availability, hire charges and delivery arrangements.

Why do different surgeons give different instructions?

Research has not established one positioning routine for every retinal problem. Trials of face-down positioning after macular-hole surgery have used different durations and compared different alternatives.

These studies do not establish one universal fallback position, and they do not determine the best position for an individual retinal detachment. Your surgeon considers the size and location of the problem, the operation and the bubble used, as well as your ability to position. Follow your own plan even if another person's instructions sound less demanding.

For context, gas and positioning are not needed after every operation for floaters. The article on recovery after vitrectomy for floaters explains why that recovery can differ from surgery for a macular hole or retinal detachment.

What precautions continue after positioning finishes?

Finishing positioning does not mean the gas has gone. Gas can remain for weeks, depending on the bubble used. Until it has completely disappeared and your surgeon has cleared you, do not fly. Ask about mountain travel or other altitude changes, including the route home: lower air pressure can enlarge the bubble and dangerously raise eye pressure.

Do not receive nitrous oxide, including “laughing gas” or gas-and-air pain relief, while gas remains. Tell doctors, dentists, anaesthetists and ambulance staff that you have gas in your eye. Carry your gas warning card and retain any warning wristband as instructed.

Do not drive while gas remains. Restart only when your vision is safe and you have been cleared. Continue eye drops and follow-up as prescribed; the positioning finish date does not automatically change those instructions either.

When should I seek urgent help?

Seek urgent advice for severe or increasing eye pain, sudden worsening of vision, a new curtain or shadow, or increasing redness or discharge. Contact your surgeon or the emergency number on your discharge instructions. Dr Chen's clinic number is 02 9424 9999. If you cannot reach the team promptly, go to an emergency department. Do not wait for the next scheduled appointment.