The term retinal cyst was introduced in 1963 by Pischel [3]. He classified such cysts into four types: (1) small cysts: approximately 1 mm in size; (2) intermediate or isolated cysts: 4 to 8 PD in size; (3) giant cysts: 8 to 10 PD in size; and (4) large retinoschisis: this type of cyst is larger than (3) and occupies at least 25% of the fundus. Pische's analysis also suggested that retinal cysts larger than 4 PD in diameter or larger than 1 mm with flashing lights and blackout sensations were of therapeutic interest and recommended treatment including scleral electrocoagulation, laser photocoagulation, scleral puncture, or a combination of these methods. The cyst in this case was approximately 10 PD in size, so it was more appropriately called a giant cyst. On B-scan, the retinal cyst was seen as a typical cystic echogenic area located on the retinal detachment band, and the retinal detachment was associated with hemorrhage [4]. In cases of retinal detachment with hemorrhagic cysts, which are less common, B-scanning reveals a strongly echogenic band of a detached retina, on which the cysts are more often rounded, and the internal echoes are different from those of ordinary cysts, which are echo-less, due to the presence of hematopoietic cells; moreover, the concentration of hemorrhage may be manifested in the form of strips of strong echoes [5]. Many researchers have since highlighted the relationship between intraretinal cysts and long-term retinal detachment. It is generally accepted that retinal cysts are secondary to rhegmatogenous retinal detachment, and the duration of the disease is usually more than 3 months, but in the present patient, the duration of retinal detachment was shorter by only 3 days. Similarly, this patient did not have retinal tears and mainly showed retinal splitting with a shallow detachment that was confined around the cyst demarcation line. She also had a brief history of severe coughing before the onset of vision loss, and we hypothesized that her condition may have been due to the presence of a small retinal cyst prior to the severe coughing, which was stimulated by severe coughing and resulted in enlargement of the cyst and rupture of the cyst and hemorrhage. Alexander et al. [11] also reported a case of retinoschisis with intraretinal cyst hemorrhage due to roller coaster riding. Keith [1] and Sen and Mishra [6] reported a similar case of retinal cleavage with a large retinal cyst. In 1966, by studying the pathological sections of 144 eyes, Keith [1] classified retinal cysts as congenital and acquired; he found that the etiology of acquired retinal cyst included choroiditis, vascular injury, ocular trauma, and retinal detachment, etc., and surmised that its pathology progressed as follows: cystic degeneration caused by damage such as hypoxia of the retina and formation of small cystic cavities, which further fused to form a retinoschisis and ultimately progressed to retinal cyst. There have also been reports of cases where retinal cysts can be secondary to systemic amebas, Klebsiella, Echinococcus infections, and cerebral cysticercosis [7–9]. Currently, the treatment of retinal cysts has been reported to be inconsistent. Cai et al. [10] concluded that vitrectomy combined with retinotomy is very effective in removing large cysts and providing adequate relief from retinal traction, but Brent et al. [11] emphasized that there is still a place for conservative treatment. This case report describes the use of scleral buckling with external compression combined with external drainage of intracystic fluid for the treatment of a large intraretinal cyst with retinal cleavage. Initially, this patient showed no significant change in the cyst after 3 months of conservative treatment; then, after scleral buckling with external compression combined with extracapsular drainage of intracapsular fluid, the patient's retina was well restored. Scleral buckling allows flattening of the retina with essentially no disturbance of the vitreous, while external scleral drainage under direct observation allows for more complete removal of subretinal and intracystic fluid and avoids the risk of medical rupture of the highly mobile retina. In addition, drainage of subretinal fluid containing retinal pigment epithelial cells and other cytokines from the outside could theoretically prevent this inflammation by preventing this environment from entering the vitreous cavity and inner surface of the retina to reduce the risk of proliferative vitreoretinopathy. This is why the external approach has the advantages of being less invasive, yielding fewer complications, and avoiding secondary surgery. We are well aware that external drainage of intraretinal cyst fluid without causing medical retinal tears is the key to successful surgery. It is worth noting that in the previous literature, vitrectomy was often used to remove cysts in such patients, with more surgical complications, whereas in our patient, an external approach was used; there have been no reports on the use of scleral buckling with external compression combined with external drainage of intracapsular fluid to treat retinal cysts, which provides a new way of considering and approaching the treatment of subsequent cases.