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Understanding Face-Down Positioning After Retinal Surgery

A Guide for Patients

You have recently undergone, or about to undergo, a retinal procedure aimed at restoring your vision and eye health. During your visit, your physician may have mentioned face down positioning.

For many of our patients, post-surgery face-down positioning becomes pivotal in ensuring the success of the operation. Understanding its importance, how to do it effectively, and managing it at home can significantly contribute to a smooth recovery process.

Why Face-Down Positioning?

Face-down positioning, or prone positioning, after retinal surgery is crucial as it helps promote the healing and attachment of the retina. This specific posture aids in reducing the strain on the operated eye, allowing the gas or oil bubble (used to support the retina during healing) to press against the affected area, promoting proper healing and reattachment of the retina. It is also commonly used with epiretinal membranes and macular holes to help facilitate healing as well.

Schematic of gas in vitreous cavity in face-down position.

At-Home Positioning Techniques

Pillows and Cushions:  Utilize pillows or cushions to create a comfortable face-down position while seated on a regular chair or lying face down on a bed.

Adjustable Furniture:  You may already own furniture that can be adjusted to help you position face-down. Some patients find they are able to lie prone on reclined adjustable chairs or beds to allow a face-down angle. This may help to ensure comfort during extended periods in this position.

Supporting the Neck:  Avoiding neck strain during post-surgical positioning can be difficult. Remember that the neck cannot hold the weight of the head for long periods of time.  Therefore, while facing down, keep support on your forehead, cheeks, or chin to assist with this weight. Remember not to put pressure on the surgical eye.

Use of Specialty Equipment:  Our office has a list of specialized companies that help our patients rent specialized equipment for post-surgical positioning. These include items like a face-down support chair or a massage table with a face hole to make it easier to maintain this position comfortably. These can be obtained with short notice and often are able to be delivered directly to your home.

Tips for Sleeping Face Down

 Pillows for Support:  Use soft pillows or cushions to support your head and face comfortably while lying down.

Side Sleeping with Support:  Try lying on your side (if allowed by your surgeon) or abdomen, and turning your neck to ensure the operated eye is facing downwards, with adequate support to maintain the position without discomfort.

Experiment with Positions:  If face-down sleeping is challenging, find variations that maintain the downward gaze while also ensuring restful sleep.

General Tips for Comfort

Frequent Breaks:  Take short breaks from face-down positioning to avoid excessive strain. Your surgeon will advise on the duration and frequency of breaks suitable for your recovery. In general, we try to keep our breaks to under 5 minutes out of every hour.

Stay Engaged:  Engage in activities like listening to audiobooks, podcasts, or watching television to help pass the time during face-down positioning. These can often be achieved by lying a phone or tablet on the floor. While reading for short periods of time is generally permissible, try to minimize reading for pleasure, as it moves your eye excessively back and forth along the page which can lead to damage to the retina during the recovery process.


 Avoid Pressure on the Operated Eye:  Ensure there is no direct pressure on the operated eye during positioning. Discomfort, pain, or a sudden change in vision should be reported to your surgeon immediately.


Always follow your surgeon’s specific instructions regarding face-down positioning after retinal surgery. Every patient’s recovery may differ, so personalizing your positioning technique based on your comfort level is crucial.

Remember, while face-down positioning might feel challenging initially, it plays a vital role in the success of your retinal surgery. Patience, adherence to instructions, and seeking assistance from your healthcare team when needed are essential elements for a successful recovery.

Lincoln Shaw M.D.

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