It is hypothesized that the primary underlying cause of the idiopathic uveal effusion syndrome is a congenital anomaly of the sclera, and in some cases, the vortex veins. Superimposed aging and hormonal changes in the sclera and its emissary channels impair its permeability to protein and predispose the eye to vortex vein obstruction. The inability of the eye to transport extravascular protein across the abnormal sclera is probably the cause of prolonged exudative detachment of the uvea and retina in these patients. Partial thickness sclerectomies and sclerostomies without choroidal puncture in each quadrant near the equator caused prompt resolution of long-standing uveal and bullous retinal detachment in two eyes.