Heavy silicone oil does not have any evidence-based advantages or disadvantages over conventional silicone oil. It is up to the surgeon to choose the type of tamponade considered to be most suitable for the individual eye. Suitable indications for heavy silicone oil are, for example proliferative vitreoretinopathy (PVR) and risk of PVR in the lower retina. Persistent or complicated macular holes can often be closed with heavy oil but in exchange higher rates of emulsification and cataracts are to be expected. Heavy silicone oils should not remain in the eye for longer than approximately 2 months, therefore, severe ocular trauma and ocular hypotension are not suitable indications. Initial technical difficulties to remove sticky (rare) oil from the retina have now been overcome by using liquid perfluorocarbons.