OBJECTIVE: To evaluate the efficacy of silicone oil as an intraocular tamponade for complicated retinal detachments in the pediatric population. DESIGN: Case series. SETTING: Referral practice at a major university hospital eye center. PATIENTS: Consecutive referred sample of 48 cases of complicated retinal detachments in children 16 years old or younger. Forty-two percent of the patients had traumatic injuries, and 35 of the eyes had undergone at least one previous retinal surgery. The minimum follow-up was 6 months, with an average follow-up of 23 months. INTERVENTIONS: Pars plana vitrectomy, silicone oil injection, and advanced vitreoretinal surgical techniques. MAIN OUTCOME MEASURES: Successful repair of complicated retinal detachment, improved visual acuity post-operatively, and frequency of complications. RESULTS: The postoperative visual acuity at the last follow-up examination was counting fingers or better in eight (17%) of the 48 cases, and only two eyes saw 20/200 or better. In the 46 eyes in which the retinal status could be determined, 16 retinas (35%) were successfully reattached at last follow-up. Significant complications included corneal opacification (62%) and hypotony (58%). Postoperative glaucoma was not a problem. CONCLUSIONS: In the pediatric population with complicated retinal detachments, silicone oil used for intraocular tamponade has disappointing results due to a low rate of sustained retinal reattachment, poor visual rehabilitation, and a high complication rate.