Scleral buckle surgery is usually performed under a local anaesthesia with sedation. General anaesthesia can be considered if the surgery is expected to take a long time. A large incision is made through the conjunctiva, which is the thin layer covering the white of the eye. The muscles on the outside of the eye are freed from the surrounding connective tissue. The silicone buckle is placed onto the outer wall of the eye (sclera) and under the muscles, and is sewn tightly so that the wall of the eye is pushed inwards. This has the effect of bringing the wall of the eye closer to the detached retina and retinal tear, which reduces the inflow of fluid under the retina. Over time, the fluid under the retina is absorbed and the retinal tear is sealed with laser or cryotherapy (freezing treatment). If there is a lot of fluid under the retina, it can be drained through a small hole made through the sclera. A bubble of air or gas is sometimes injected to hasten reattachment of the retina. Finally, the conjunctiva is stitched close.

Complex retinal detachments caused by scarring of the retina may require both vitrectomy and scleral buckle to successfully reattach the retina. Examples include severe diabetic retinopathy and failed retinal detachment repair.

Most patients feel some discomfort following scleral buckle surgery. Occasionally the discomfort can be significant. The eye pressure needs to be monitored closely during recovery. Because the surgery disrupts the muscle position, double vision may appear but in most people the symptom settles. If a lot of scarring develops around the muscles, double vision can appear later due to the restriction of muscle movement. The buckling tends to lengthen the eye, causing some shortsightedness that will require glasses correction. A small number of patients develop chronic irritation or intolerable double vision, requiring removal of the buckle. Rarely, the buckle can become infected and cause an acute red eye, which must be managed urgently.