Abstract: Expulsive suprachoroidal hemorrhage (ESCH) is a rare,  but one of the most severe and frightening complication of intraocular surgery. It may involve the ciliary body,  vitreous,  and retina,  and can cause complete loss of vision. The pathogenesis of ESCH is unclear,  but it is related to choroid tissue composition and blood supply. Previous studies have shown that one of the most important triggers of ESCH is the sudden drop of intraocular pressure,  which often occurs during and after cataract surgery,  glaucoma surgery and vitrectomy.B-scan ultrasonography can diagnose ESCH and observe the degree of coagulation in the suprachoroidal space,  which helps to determine the timing of surgery. Surgery is the most important treatment for ESCH, early suprachoroidal drainage can save the remaining vision,  but the effectiveness of different drainage methods is controversial. ESCH can be effectively avoided by paying attention to the management of risk factors before surgery,  careful operation during surgery and timely detection of suprachoroidal hemorrhage (SCH). (Int Rev Ophthalmol, 2022, 46:  522-527)