AIM: To elucidate the manifestations and associated complications observed in patients with intraocular silicone oil (SO) emulsification through multiple imaging modalities. METHODS: This single-center, observational, retrospective study included 116 patients who underwent pars plana vitrectomy (PPV) with SO injection for retinal detachment (RD), followed by subsequent SO removal at the Second Hospital of Hebei Medical University from January 2013 to January 2023. Comprehensive records of ophthalmic examinations utilizing multiple imaging techniques were maintained. RESULTS: The study comprised 56 females and 60 males, with a mean age of 52.75±13.6y. The mean follow-up duration for SO tamponade was 9.04±11.33mo (range: 1-84mo). Among the participants, 59 patients were diagnosed with SO emulsification, while 57 patients were in the SO unemulsified group. Patients with SO emulsification had a significantly prolonged SO tamponade duration (P<0.01). Multiple imaging techniques revealed notable signs of SO emulsification and its complications, such as 4 cases (3.4%) with posterior corneal SO-like keratic precipitates (KP) observed by anterior segment photography, 23 cases (19.8%) exhibiting spherical high-reflection signals in the inter-retina, retinal pigment epithelium, or choroid detected by Spectralis spectral domain optical coherence tomography (SD-OCT), 4 cases (3.4%) showing slow movement of emulsified SO droplets within retinal vessels during fluorescein angiography (FFA), plain and enhanced head magnetic resonance imaging (MRI) images of these four patients did not detect emulsified SO in the lateral ventricles, suprasellar cistern, subarachnoid space, third ventricle, fourth ventricle, or other intracranial locations. CONCLUSION: Intraocular emulsified SO can lead to damage in both anterior and posterior segment tissues, encompassing corneal degeneration, cataracts, glaucoma, retinal and choroid inflammation. Objective multiple imaging techniques such as anterior segment photography, SD-OCT, FFA, and MRI offer comprehensive evaluation and diagnosis of SO emulsification and its associated complications.