👓 Ophthalmology Aftercare
Macular Hole Surgery Aftercare Instructions
A day-by-day recovery guide for macular hole surgery: what to expect, how to care for yourself, and when to call. Free to read and print.
Typical recovery: about 42 daysOphthalmology
What to expect
Face-Down Positioning is Non-Negotiable
- •The success rate of macular hole closure drops significantly without proper positioning
- •Rent specialized equipment if possible: face-down chairs, adjustable tables, and sleeping supports
- •Arrange help for meals, household tasks, and childcare during the first 1 to 2 weeks
- •Neck and back soreness from positioning is common; gentle stretches during breaks help
No Flying Until Gas Absorbs
- •Cabin pressure changes at altitude cause the gas bubble to expand, which can cause dangerous eye pressure
- •This includes helicopter rides, unpressurized aircraft, and driving over high mountain passes
- •Your surgeon will confirm when the gas has fully absorbed (usually 6 to 8 weeks)
Macular Hole Surgery recovery, day by day
Day 0 (Surgery Day)
Face-Down Positioning (Critical)
- Begin STRICT face-down positioning immediately after surgery. This is the single most important factor in successful closure.
- Face down means your face points toward the floor at all times: sleeping, sitting, eating, and resting
- Maintain face-down position for a minimum of 45 to 50 minutes out of every hour for the first 7 to 14 days
- Use a face-down support pillow, massage table, or rented positioning equipment for comfort
Eye Care
- Wear the protective eye shield at all times, including during sleep
- Start prescribed eye drops as directed: antibiotic drops and anti-inflammatory drops
- Wait 5 minutes between different types of eye drops
- Do NOT rub or press on the eye. Do not get water in the eye.
Day 1-7 (Strict Positioning Phase)
Positioning Compliance
- The gas bubble inside your eye holds the macular hole closed while it heals. Face-down positioning keeps the bubble in contact with the macula.
- Take 10 to 15 minute breaks per hour to stretch your neck and back, but return to face-down immediately
- Eat meals face-down by placing your plate below you on a low table
- Sleep face-down using a U-shaped pillow or with your face in a massage headrest
Activity Restrictions
- Do NOT fly in an airplane or travel to high altitudes until the gas bubble has fully absorbed (typically 6 to 8 weeks)
- Do NOT lie on your back. The bubble will press on the lens and cause a cataract or high eye pressure.
- No bending at the waist, heavy lifting (over 5 lbs), or straining
- No reading, screens, or activities that require looking up for the first week
Day 8-14 (Gradual Position Relaxation)
Transition
- Your surgeon will advise when to reduce positioning; typically at 7 to 14 days depending on hole closure
- You may be allowed to alternate between face-down and side-lying positions
- Continue all eye drops on schedule until completed
- Vision will be very blurry while the gas bubble is present; this is expected and temporary
Week 3-6 (Gas Absorption Phase)
Gas Bubble Absorption
- The gas bubble gradually shrinks over 6 to 8 weeks. You will see a dark line or bubble edge that rises as the gas absorbs.
- Vision slowly improves as the bubble absorbs and is replaced by your natural eye fluid
- Still NO air travel or altitude changes above 2,500 feet until the bubble is fully gone
- Resume normal activities gradually. No contact sports or swimming until cleared by your surgeon.
Follow-Up
- Attend all post-operative appointments (typically day 1, week 1, week 4, and week 6 to 8)
- Final visual acuity outcome may take 3 to 6 months to stabilize
- Report any sudden increase in floaters, flashing lights, or vision loss immediately
- Cataract development is common after vitrectomy; your surgeon will monitor for this
When to call your provider or 911
- •Sudden loss of vision or dramatic decrease in vision in the surgical eye
- •Severe eye pain that worsens or does not respond to prescribed medication
- •Sudden increase in floaters, flashing lights, or a curtain-like shadow in your vision
- •Increasing redness, swelling, or pus discharge from the eye
- •Severe headache with nausea (possible high eye pressure)
- •Fever above 101.5 degrees F (38.6 degrees C)
When in doubt, call your clinic. For a medical emergency, call 911.
Recovery milestones
- Day 0
Positioning begins
Strict face-down positioning starts immediately
- Day 1
First post-op check
Surgeon confirms hole closure status via OCT imaging
- Day 10
Positioning may be relaxed
Surgeon evaluates hole closure and adjusts positioning requirements
- Day 28
Gas bubble absorbing
Bubble edge visible and dropping; vision gradually improving
- Day 42
Expected recovery
Gas fully absorbed, vision stabilizing, all restrictions lifted
For clinics
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