Scleral buckle infection following retinal reattachment surgery is infrequent but not rare. We identified 45 cases among approximately 3000 scleral buckling procedures performed at our institution between July 1, 1985 and July 1, 1991. The scleral buckle was exposed in all 45, and the subsequent microbiologic culture was positive in 33. The most common causative organism was coagulase negative staphylococci (17 of 33 cases with positive cultures). Risk factors for an adverse outcome included positive culture, preoperative vision < or = 20/200, and preoperative retinal detachment. Broad spectrum antibiotics covered organism sensitivity profiles in 16 of the 18 cases tested. Prompt removal of infected buckles and treatment with broad-spectrum topical antibiotics are important for maintaining vision.